Lupus Erythematosus

Question 1

What is systemic lupus erythematosus?

Answer 1

Systemic lupus erythematosus (SLE) is a chronic inflammatory
disease associated with the production of antinuclear antibodies.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 456

Question 2

What are the most common symptoms of systemic

lupus erythematosus?

Answer 2

The most common presenting symptoms are polyarthritis and
dermatitis. A malar rash occurs in about 1/3 of SLE patients.
Renal disease occurs in over half of the patients with SLE and
is the most common cause of death. About 10-20% of patients
with lupus erythematosus require dialysis. Because of the
increased risk of vasculitis, these patients have a higher risk of
CNS disorders such as seizures, stroke, dementia, peripheral
neuropathy, and psychosis. A diffuse serositis results in
pericardial effusion in over half of these patients, but pericardial
tamponade is rare.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 634.

Question 3

What patients exhibit the highest incidence of

systemic lupus erythematosus?

Answer 3

SLE is typically seen in young women (incidence is
approximately 1 in 1000 females). The disease is most
common in women of African and Asian descent.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 456

Question 4

What drugs are used to treat systemic lupus

erythematosus?

Answer 4

Corticosteroids are helpful in the treatment of moderate to
severe SLE. Antimalarials are effective in the treatment of
arthritis and dermatitis. Immunosuppressants such as
azathioprine, methotrexate, cyclophosphamide, and
cyclosporine help reduce symptoms and reduce corticosteroid
dose requirements.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 634-635.

Question 5

What conditions and drugs can precipitate an

exacerbation of systemic lupus erythematosus?

Answer 5

Infection, pregnancy, and surgical stresses can precipitate an
exacerbation of SLE. Over 80 drugs have been reported to
precipitate an SLE exacerbation, but procainamide, hydralazine,
captopril, enalapril, isoniazid, d-penicillamine, and methyldopa
are the drugs most frequently implicated in SLE exacerbation.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 456-457.

Question 6

What are the pulmonary effects of systemic lupus

erythematosus?

Answer 6

Patients with SLE are prone to pleural effusion, pneumonitis,
alveolar hemorrhage, and pulmonary hypertension. The end
result is a restrictive defect.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 634

Question 7

What are the airway implications of systemic lupus

erythematosus?

Answer 7

About 1/3 of patients with SLE exhibit cricoarytenoid arthritis
and recurrent laryngeal nerve palsy.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 456-457.

Question 8

A patient with systemic lupus erythematosus takes
corticosteroids and cyclophosphamide. How might
this alter your anesthetic plan?

Answer 8

The patient may require additional corticosteroids during the
perioperative period. Because cyclophosphamide inhibits
plasma cholinesterase, the effects of ester local anesthetics and
succinylcholine may be prolonged.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 635.