SLE ☺️ Flashcards
Epidemiology
Etiology
Pathophysiology
Female, 20-40s
Afro Caribbean, Asian
AI T3 hypersensitivity
-HLA B8, DR2-3
immune system dysregulation => immune complex formation, deposits in any organ
Presentation
- general features
- skin
- MSK
- CV, resp
- renal
- psych
General
-fatigue, fever, mouth ulcers, lymphadenopathy
Skin
- photosensitivity
- malar/discoid in sun exposed areas/non scarring alopecia
- Raynaud’s, nailfold capillaries
MSK
-non erosive arthritis
CV
- pericarditis
- pulmonary fibrosis
Renal
-glomerulonephritis
Psych
-A+D
Investigations
AB - ANA, dsDNA, Smith
-Ro, La
High ESR
Low C3,4 (formation of complex => depletion)
Management
- lifestyle
- mild
CV risk factors
-exercise, alcohol, smoking, diet
Sun protection
Mild - HCQ + NSAIDS/CS
-can add methotrexate
Moderate - HCQ + immunosuppressive steroid sparing
Severe - lupus nephritis, neuropsychiatric lupus
-intensive immunosuppression + prolonged maintenance to prevent relapse
Belimumab, rituximab can only be used if criteria for use met
What is renal nephritis
- assessment
- management
Severe complication => ESRF
- regular urinalysis for proteinuria
- renal biopsy - diffuse proliferative GN due to immune complex deposits (most severe and common)
Management
- HTN treatment
- CS and immunosuppresants (azathiopurine)
What is the diagnostic criteria for SLE
Minimum of 4 criteria -at least 1 clinical criterion -at least 1 immunological criterion OR lupus nephritis as the sole criterion in the presence of ANA or anti dsDNA