Rheumatology: SLE Flashcards
Outline the pathophysiology of SLE
Multisystemic autoimmune disease
Polyclonal B cell secretion of pathogenic auto-Ab = immune complex formation and deposition, complement activation = tissue damage
How is SLE diagnosed?
> 4 out of 11 features (SOAP BRAIN MD)
- Serositis = pleuritis, pericarditis
- Oral ulcers
- Arthritis
- Photosensitivity
- Blood = HA, leukopenia, thrombocytopenia
- Renal = persistent proteinuria, cellular casts
- Antinuclear antibody (ANA Ab)
- Immunological = Anti-dsDNA, anti-SM, antiphospholipid
- Neurological = seizures
- Malar rash (butterfly)
- Discoid rash
What symptoms and signs are seen in SLE?
Butterfly rash
Malaise
Fatigue
Fever
Myalgia
Lymphadenopathy
Weight loss
Alopecia
Nail fold infarcts
Non-infectious endocarditis
Raynaud’s
Migraine
Stroke
Retinal exudates
What investigations should be performed for a pt with suspected SLE?
95% are ANA +ve
60% are anti-dsDNA
Anti-Sm
Anti-phospholipid Ab
FBC (anaemia), U+Es, LFTs, CXR, ECHO, biopsy
How is SLE managed?
Acute flare up = IV cyclophosphamide + high-dose PO prednisolone
Prevent rashes with high-factor sunblock cream
Joint/skin symptoms = NSAIDs, hydroxychlorquinine
ACEi = proteinuria, HTN
Methotrexate
Lupus nephritis = cyclophosphamide
Name some potential complications of SLE
Pneumonia
Bleeding into the lungs
Pericarditis
Kidney failure
Anaemia
What is methotrexate?
Anti-inflam - inhib IL-1
Inhibits proliferation of the lymphocytes and other cells responsible for inflammation in the joint
1 a week - 2.5mg or 10mg tabs, subcut injection
Monitoring (fortnightly bloods)
- Liver = LFTs
- Bone marrow = decreased RBCs
- Lung scaring = CXR
Also give folic acid to reduce SE
SE = nausea, vomiting, diarrhoea, mouth ulcers, hair loss, skin rashes
Indication = RA, psoriatic arthritis, juvenile idiopathic arthritis, vasculitis, cancer (higher dose)
Do not take - trimethorprim, phenytoin (epilepsy), theophylline (asthma)
