Rheumatology

Question 1

Define SLE

Answer 1

A chronic multi system inflammatory disease of unknown origin characterised by autoantibody production

Question 2

Causes of lupus

Answer 2

Genetic (HLA, abnormal complement pathway)
Hereditary
Hormonal (increased oestrogen)
Drugs (INH, hydralazine)
UV light, smoking, Vit D deficiency
EBV exposure

Question 3

Diagnostic criteria used to diagnose lupus

Answer 3

SLICC diagnostic criteria (>/=4 criteria with at least 1 clinical and 1 lab)
OR
Biopsy proven lupus nephritis with positive anti-DNA or ANA

Question 4

Clinical features of SLE

Answer 4

Serositis (pericarditis, pleuritis)
Oral/nasal ulcers
Arthritis (>2 joints)
Photosensitivity

Blood disorder (thrombocytopenia, leukopenia, lymph open is, haemolytic anaemia)
Renal disorder (increased protein in urine = >0,5mg/l)
Antibodies (ANA, Anti-DNA, Anti,Smith, Anti-phospholipid)
Immunological (anti-DNA, Antismith etc)
Neurological (psychosis, peripheral neuropathy, headaches)

Malar rash
Discoid rash

Question 5

What indicates active disease in lupus?

Answer 5

Positive anti-DNA antibodies, positive anti-smith antibodies, decreased C3 and C4

Question 6

What is a complication of lupus and how can you treat it?

Answer 6

Lupus nephritis (>500gproteinuria in 24hrs)/renal biopsy

Treatment: steroids, BP control, cyclophosphamide’s

Question 7

What is the management of lupus?

Answer 7

1) lifestyle
>stop smoking
>diet and exercise
>immunisations before immunosuppressants
>sunscreen
>avoid pregnancy during active disease
2) chloroquine (suppress disease activity)
3) symptomatic treatment
>skin: sunscreen, chloroquine
>arthritis: DMARDS (start non-biological = methotrexate,chloroquine), steroids, NSAIDS
>nephritis: steroids, cyclophosphamide’s
>Serositis: steroids, NSAIDS
>thrombocytopenia: steroids, splenectomy, IVIG

(Resistant tx = bDMARDs = retuximab, cyclosporine)

Question 8

Investigations/work up a lupus patient

Answer 8

1) Bloods
>FBC (pencils)
>antibodies
>ESR and CRP (inflammation)
>u&E and LFT, creatinine
2) urine
>24hr urine protein
>dipstix
>protein/creatinine ratio
3) other
>kidney biopsy
>echo: cardiac involvement
>X-ray/ultrasound of specific joint/organ involved
>lupus band test