Rheum - SLE Flashcards
what is SLE?
Autoimmune condition causing inflammation of joints, skin and other organs.
suggest risk factors for SLE
- female (9:1 F:M)
- Afro-Caribbean
- UV light
- viruses, e.g. EBV
- drugs: chlorpromazine, methyldopa, hydralazine, isoniazid…
suggest common symptoms of SLE
- fatigue (can be severe)
- arthralgia (often with early morning stiffness, although joint swelling unusual)
- myalgia
- pleuritic chest pain
- malaise, weight loss
- headache
- dry eyes and mouth
- Raynaud’s syndrome (1/5 cases)
- mouth ulcers (serositis)
suggest possible signs of SLE
- fever
- photosensitive rash, malar rash, discoid rash
- lymphadenopathy
- splenomegaly
- mild hair loss
- Jacoud’s arthropathy (joint deformity and subluxation when tendons and peri-articular soft tissue are affected)
how can SLE affect the kidneys?
Glomerulonephritis is common (50% have proteinuria/casts).
Often asymptomatic and detected by proteinruia, haematuria, HTN or increase in serum urea and creatinine.
how can SLE affect the lungs?
- interstitial lung disease
- bronchiectasis
- pleural effusions
- increased risk of PE, esp. if have secondary anti-phospholipid syndrome
how can SLE affect the CVS?
- Libman-Sacks endocarditis (non-infective)
- pericarditis
- idiopathic, recurrent cardiac tamponade
- HTN
- increased risk of CHD
what are the possible neuropsychiatric effects of SLE?
- anxiety and depression common
- psychosis
- seizures
- neuropathy
- meningitis
- increased risk of stroke (vasculitis or thrombosis in anti-phospholipid syndrome)
name common auto-antibodies found in SLE
- ANA
- anti-dsDNA (increased risk of lupus nephritis if high - do renal biopsy)
- anti-Sm (v. specific to SLE)
- anti-Ro and -La (risk of foetal congenital heart block in pregnant lady)
what is antiphospholipid syndrome?
autoimmune disorder characterised by arterial and venous thrombosis and adverse pregnancy outcomes. Due to antiphospholipid (aPL) antibodies which have hypercoagulable effect,
30% SLE pts +ve for aPL Abs.
how would you manage a pt with mild-moderate SLE?
- Analgesics and NSAIDs: for joint and muscle pain and headaches
If above are insufficient:
- corticosteroids: v. effective for flare ups but increased risk of infection, CVD and osteoporosis
- DMARDs:
- hydroxychloroquine (1st line)
- azathioprine: used as steroid-sparing agent, but not as effective as others
- mycopheonlate mofetil: more effective then azathiprine
which drug would you use in an SLE pt with life-threatening disease, e.g. lupus nephritis vasculitis or cerebral disease? name a severe side effect of this drug
Cyclophosphamide
Very toxic, can cause haemorrhagic cysitits (use with prophylactic mesna)
name a monoclonal Ab that may be used in refractory SLE
Belimumab: inhibits B cell stimulator activity
