SLE Flashcards
what type of disease is SLE ?
autoimmune disease
what is the presentation of SLE?
fatigue, lethargy, fever, weight loss
skin rashes
mouth ulcers
hair loss
Raynaud’s Phenomenon
aching joint
what are the cutaneous manifestations ?
photosensitive ( most common)
raised erythematous malar rash
discoid malar rash
mouth/vaginal/nasal ulcers
alopecia
what are the muscoskeletal manifestations ?
polyarthritis
jaccoud’s arthropathy ( similar to RA but correctable)
Myositis
arthritis
what are the cardiovascular manifestations ?
pericarditis - usually responds to NSAIDs
myocarditis
MI
vasculitis
what are the renal manifestations ?
mild glomerulonephritis
lupus nephritis
what are the hematological manifestations ?
anemia
leukopenia
thrombocytopenia
what are the ACR classification criteria ?
A RASH POINTS MD
1- facial rash sparing the nasolabial fold (butterfly rash)
2- discoid rash
3- photosensitivity
4- oral or nasopharyngeal ulcerations
5- non-erosive arthritis
6- serositis
7- renal disorders
8- haematological disorders
9- neurological disorders
10- immunological
11- ANA positive
how many of the ACR classification are required for a diagnosis ?
4 out of 11
what other investigations are required for a diagnosis of SLE ?
- CBC, ESR, liver function, kidney function, urine analysis and 24 hr protein
- kidney biopsy and sometimes skin biopsy
- MRI brain in cases of CNS lupus may be required
what is the management for SLE ?
analgesics local treatments such as SPF NSAIDS steroids DMARDS Immunosuppressants - azathioprine and cyclophosphamide biological treatments ( if not responding to conventional treatment )
what is the management for psychoses and seizures in CNS lupus ?
anticonvulsants
antipssychotics
antipsychotics
what is the management for status epilepticus and coma in CNS lupus ?
pulse methyprednisolone
IV cyclophosphamide
and/or plasmapheresis
what is antiphospholipid syndrome ?
a disease that may be idiopathic or happens along with autoimmune disease where the patient experiences a hypercoaguable state
what is the requirement to make a diagnosis of antiphospholipid syndrome ?
requires one clinical criteria ( thrombotic event or pregnancy complication) along with two antibody blood test spaced at least 3 months apart
- lupus anticoagulant
- anticardiolipin antibody
- beta 2 glycoprotein
what are the prophylactic measures for APS ?
low does aspirin
aspirin and anti coagulant
what would we give a pregnant female with antiphospholipid ?
aspirin and low molecular weight heparin
generally what is thee first line treatment for patients with APS after a thromboembolic event ?
warfain
what is the presentation like in pregnant women with SLE?
1st trimester - active disease
2nd to 3rd trimester - antiphospholipid syndrome
what are the variants of SLE ?
chronic discoid lupus DLE subacute cutaneous lupus SCLE neonatal Lupus Lupus in the elderly drug induced lupus
what are the features of chronic discoid lupus DLE ?
usually really low or ANA negative
what are the features of subacute cutaneous lupus ?
ANA positive
non-scarring photosensitive rash
anti-ro antibody
Anti-Ro antibody
when does neonatal lupus happen ?
neonates are born to mothers with Ro antibody
associated with 3 Hs :
hematological problems
heart block k
hepatobiliary disease
what are the drugs that could induce lupus ?
procainamide
hydralazine
isoniazid
anticonvulsants
what are the features of drug induced lupus ?
ANA positive mainly histones and ssDNA
mainly histones and ssDNA
what are the features of sjorgen’s syndrome ?
dry eyes
dry mouth
positive schrimer’s test
serology ro positive
anti-la negative
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what are the cutaneous manifestations associated with associated with DLE ?
discoid malar rash
circular scaly hyperpigmented lesions
erythematous rim
atrophic centre
if a single joint has persistent pain in a patient with SLE what should be considered ?
osteonecrosis
what does jaccoud’s arthropathy look like ?
ulnar deviation of the 2nd to 5th fingers with metacarpophalangeal joint subluxation
what are the features associated with lupus inn the elderly ?
insidious onset
interstitial lung disease is common
CNS and renal not common
what is the the INR target when warfarin is used ?
INR 2-3
