SAQ 2

Question 1

A 16-year-old black female presents to her general practitioner with symptoms of fatigue and a facial rash. On examination she is noted to be thin with malar skin changes.
You suspect she has Systemic Lupus Erythematosus (SLE).

Question 1: What two additional symptoms would you explore to aid confirmation of your diagnosis? Only the first two answers will be considered. (2 marks)

Answer 1

Any two from:
Oral ulcers on palate
Pain in the chest, or SOB - pleurisy.
Musculoskeletal pain - arthritis in small joints
Seizures/psychosis - neurological disorders

Question 2

A 16-year-old black female presents to her general practitioner with symptoms of fatigue and a facial rash. On examination she is noted to be thin with malar skin changes.
You suspect she has Systemic Lupus Erythematosus (SLE).

Question 2: What investigations would you order to help confirm this diagnosis before referring the patient to Rheumatology? (2 marks)

Answer 2

Need to list 4 for 2 marks:
Blood tests - FBC 
Coagulation - aPTT 
ESR and/or CRP 
Antibodies - ANA, dsDNA Smith antigen (antiSm)
Urinalysis 
Chest XR

Question 3

A 16-year-old black female presents to her general practitioner with symptoms of fatigue and a facial rash. On examination she is noted to be thin with malar skin changes.
You suspect she has Systemic Lupus Erythematosus (SLE).

Question 3: Investigations come back and SLE is confirmed. Blood tests are abnormal. What are they likely to show with a diagnosis of SLE? (1 mark)

Answer 3

Autoimmune (0.5mark) Haemolytic Anaemia (0.5marks)

Question 4

A 16-year-old black female presents to her general practitioner with symptoms of fatigue and a facial rash. On examination she is noted to be thin with malar skin changes.
You suspect she has Systemic Lupus Erythematosus (SLE).

Question 4: What non-pharmacological advice/treatment could you discuss with the patient about managing their condition? (2 marks)

Answer 4

Any 2 from:
Sun protection should be used (SPF50+) as exposure to UV light may exacerbate or induce systemic manifestations of SLE. / Avoid excessive sun exposure and use a broad spectrum sunscreen.
Lifestyle modifications: Premature Cardiovascular disease is a complication of SLE - maintianing healthy diet/avoid sedentary lifestyle
Smoking cessation - smoking is associated with more active disease
CBT - SLE has a impact on suicide ideation and attempt.

Question 5

A 16-year-old black female presents to her general practitioner with symptoms of fatigue and a facial rash. On examination she is noted to be thin with malar skin changes.
You suspect she has Systemic Lupus Erythematosus (SLE).

Question 5: After referral to Rheumatology, the general practitioner receives a letter that the patient has started immunosuppressive treatment, but requires continuation in community care.

What immunosuppressant is recommended for all patients with SLE? (1 mark)

Answer 5

Hydroxychloroquine

Question 6

A 16-year-old black female presents to her general practitioner with symptoms of fatigue and a facial rash. On examination she is noted to be thin with malar skin changes.
You suspect she has Systemic Lupus Erythematosus (SLE).

Question 6: SLE can lead to complications. When this patient chooses to start a family, what risks should she be made aware of? (2 marks)

Answer 6

Risk of miscarriage - ths is an extra-articular feature of SLE.
Risk of VTE - presence of antiphospholipid antibodies increases risk of venous or arterial thrombosis.