Rheumatology

Question 1

SLE definition

Answer 1

multisystemic autoimmune inflammatory disease in which autoABs to a variety of autoantigens result in the formation and deposition of immune complexes

Question 2

Epidemiology of SLE

Answer 2

Prev: 0.2%
Sex: F»M=9:1
Age: child-bearing age
Genetic: ↑ in Afro-Caribs and Asians

Question 3

Generic features SLE

Answer 3

relapsing remitting history 
general symptoms 
- fatigue
- weight loss
- fever
- myalgia

Question 4

Clinical features of SLE

Answer 4

A RASH POINts anMD

Arthritis - non-erosive involving peripheral joints
- Jaccoud’s is rare large joints
Renal - proteinura and increased BP
ANA +ve 95%
Serositis- pleuritis and pericarditis
Haematological - ↓WCC
- ↓Plats
- Anaemia chronic disease
Photosensitivity
Oral ulcers
Immune phenomenon - Anti dsDNA
- Anti Sm
- Antiphospholipid
Neurological - Seizures and psychosis
Malar rash- butterfly formation
Discoid rash - mainly face and chest

Question 5

Immunology test SLE

Answer 5

95% ANA +ve
ds DNA is very specific but only 60% sensitive
30% ENA positive (extractable nuclear antigen) (compiles Ro, La, Sm, RNP)
Anticardiolipin Abs

Question 6

Monitoring disease activity in SLE

Answer 6

Anti dsDNA titres
Complement decreased C3 C4
Increased ESR with normal CRP

Question 7

SLE investigations

Answer 7

Antibodies

Bloods : FBC, UE, CRP, clotting

Urine : dipstix and protein creatinine ratio >15 shows excess proteinuria
+ urine microscopy

C3 and C4 shows active flare
Anti histone indicates drug induced lupus

Question 8

Features of drug induced lupus

Answer 8

Causes- hydralazine most common (+isoniazid)
Anti-histone Abs seen in 100% cases
Mostly skin and lung signs
No serious brain and kidney involvement
Disease remits if drug is stopped

Question 9

Antiphospholipid syndrome classification

Answer 9

Primary 70%

Secondary to SLE 30%

Question 10

APS pathology

Answer 10

Generation of antiphospholipid Abs = anticardiolipin and lupus anticoagulant

Question 11

APS clinical features

Answer 11

CLOTS
Coagulation defect - increase APTT venous DVT arterial stroke

Livedo reticularis

Obstetric - recurrent 1st trimester miscarriage

Thrombocytopenia

Question 12

APS treatment

Answer 12

Low dose aspirin

Warfarin if recurrent thrombosis - INR 3.5

Question 13

Treatment SLE

Answer 13

hydroxychloroquine (everyone)
NSAIDS (everyone)
steroids (flare)
IV cyclophosphamide - (nephritis)
PO mycofenylate - (nephritis)

skin - topical steroids and sun cream

nephritis - proteinuria give ACEi

Treatment complications - can give OP and CV disease

Question 14

Prognosis SLE

Answer 14

80% survival at 15 years