SLE

Question 1

What is SLE?

Answer 1

an inflammatory disease characterized by autoantibody to nuclear material and can involve almost any organ or system of the body.

Question 2

Who does SLE mainly affect?

Answer 2

women between 15-40 years of age

Question 3

What are some clinical features of SLE?

Answer 3

• diverse and the severity of the disease varies over time.
• Initial symptoms may be mild and rather vague
• but it is the exacerbations of SLE and resultant tissue damage that cause significant ill-health
• Severe lupus flares can result in life-threatening problems, including renal failure and cerebral vasculitis.

Question 4

Describe the pathophysiology of SLE

Answer 4

• Immune function in SLE is abnormal, with T- and B-cell dysfunction causing B-cell hyperactivity and impaired immune complex clearance from tissues.
• Dysfunction of the complement system and aberrant programmed cell death mean that intracellular material is not disposed of correctly, allowing autoantibody production to develop against nuclear material.

Question 5

What are the risk factors of SLE?

Answer 5

Female:Male = 10:1
·        Age: 15-45
·        Afro-Caribbeans and Asians
·        Sun exposure
·        FHx
·        Smoking
·        Drugs: Minocycline, isoniazid, phenytoin, carbamazepine (antiepileptic), sulfasalazine

Question 6

What are factors that can trigger SLE?

Answer 6

-Overexposure to sunlight – UV light B>A
-Oestrogen-containing contraceptive therapy
-Pregnancy – pregnant women with SLE often experience severe exacerbations of the disease which can threaten the life of the foetus and the mother.
-Drugs: Hydralazine, minocycline
Infection
-Stress

Question 7

What are the signs of SLE?

Answer 7

• Raynaud’s phenomenon
• Jaccoud’s Arthropathy
• butterfly rash

Question 8

What are the symptoms of SLE?

Answer 8

• Fatigue
• malaise
• fever
• weight loss
• 90% of patients with SLE experience arthralgia, usually polyarticular
• Myalgia ( and myositis)
• butterfly rash

Question 9

What are the investigations for SLE?

Answer 9

-Bloods- auto-antibodies:
>Anti-Ro
>Anti-LA
>Anti-double-stranded DNA.

-Certain Major Histocompatibility Complex antigens, particularly HLA-DR2 and DR3, confers an increased susceptibility.

Question 10

What are the complications of SLE?

Answer 10

-Most patients die from either renal disease, cardiovascular disease (SLE is known to cause accelerated atherosclerosis, as do the glucocorticoids that are used in the treatment), or infection due to the immunosuppressive nature of the disease and its treatment

Question 11

What is the non-pharmacological treatment of SLE?

Answer 11

Avoidance of sun exposure, combined with high factor sun protection may be used for photosensitive rashes.

Question 12

What is the pharmacological treatment of SLE?

Answer 12

• Hydroxychloroquine - to alleviate symptoms in the medium term but does nothing to treat the more serious manifestations of the disease such as neurological or renal involvement.
• Glucocorticoids - Often in high dose to treat the serious manifestations (this should always be under specialist supervision).
• Immunosuppressants such as azathioprine, cyclophosphamide, and methotrexate are sometimes used in addition and also useful as steroid-sparing agents.