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Z Year3 MSK Conditions > SLE > Flashcards

SLE Flashcards

1
Q

What is SLE?

A

multisystemic autoimmune disease

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2
Q

What is the pathophysiology of SLE?

A
  1. Autoantibodies made against a lot of autoantigens (e.g. ANA) which form immune complexes
  2. Inadequate clearance of immune complexes results in a host of immune responses which cause tissue inflammation and damage
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3
Q

What are RF for SLE?

A
  1. Environmental triggers: EBV
  2. HLA B8, DR2 or DR3 positive
  3. Fhx: 10% of patients have 1st or 2nd degree relative with SLE
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4
Q

What is the prevalence of SLE?

A

0.2%

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5
Q

What is the classic epid of SLE?

A
  1. Women 9:1
  2. Child bearing age
  3. African Caribbean and Asians
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6
Q

How do you diagnose SLE?

A

least 4 or more criteria (at least 1 clincial and 1 lab) or biopsy proven lupus nephritis with positive ANA or anti-DNA

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7
Q

What are the categories of symptoms of SLE?

A
  1. Acute cutaneous lupus
  2. Chronic cutaneous lupus
  3. Non-scarring alopecia
  4. Oral/nasal ulcers
  5. Synovitis
  6. Serositis
  7. Neurological features
  8. Fever
  9. Weight loss
  10. Raynaud’s phenomenon
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8
Q

What are signs of acute cutaneous lupus?

A
  1. malar rash/butterfly
  2. fixed erythema
  3. photosensitive rash
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9
Q

What are signs of chronic cutaneous lupus?

A
  1. discoid rash

2. erythematous raised patches with adherent keratotic scale and follicular plugging

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10
Q

What does the synovitis affect?

A

2 or more joints

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11
Q

What are the serositis parts of SLE?

A

lung, pericardial effusion, pericarditis, pericardial pain

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12
Q

What are possible DDx for SLE?

A
  1. Rheumatoid arthritis
  2. Antiphospholipid syndrome
  3. Systemic sclerosis
  4. Mixed connective tissue disease
  5. Adult Still’s disease
  6. Lyme Disease
  7. HIV
    Etc
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13
Q

What blood investigations are used for SLE?

A
  1. FBC
  2. APTT
  3. U+Es
  4. ESR + CRP
  5. ANA, dsDNA, Smith antigen
  6. C3 and C4
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14
Q

What would FBC in SLE show?

A
  • haemolytic anaemia
  • leukopenia
  • thrombocytopenia
  • Leucopenia (WCC<4) at least once or lymphopenia (<1) at least once
  • Thrombocytopenia (platelets <100) at least once
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15
Q

What would APTT show for SLE?

A

prolonged in patients with antiphosphoplid antibodies

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16
Q

What would U+Es in SLE show?

A

elevated urea and creatinine

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17
Q

What does ESR and CRP like in SLE?

A

raised ESR and normal CRP

18
Q

What is ANA, dsDNA, Smith antigen like in SLE?

A

positive

19
Q

What other tests should be ordered for SLE?

A
  1. Urinalysis
  2. CXR
  3. ECG
  4. renal biopsy
20
Q

What would urinalysis show in SLE?

A
  1. haematuria or (red cell casts)

2. proteinuria (>0.5g/d)

21
Q

What neurological features are in SLE?

A

seizures, psychosis, myelitis, neuropathy

22
Q

What would CXR show in SLE?

A
  1. pleural effusion
  2. infiltrates
  3. cardiomegaly
23
Q

Why do you do ECG for SLE?

A

exclude other causes of chest pain

24
Q

What labaratory criteria is needed in SLE?

A
  1. +Ve ANA (95% positive)
  2. Anti-dsDNA
  3. Anti-smith antibodies present
  4. Antiphospholipid Abs present
  5. Low complement (C3, C4 or C50)
  6. +ve Direct Coombs test
25
Q

What criteria is used for SLE?

A

2019 European League Against Rheumatism/American College of Rheumatology classification system

26
Q

What general measures are taken in SLE?

A

high factor sunblock

27
Q

What medication is taken for the skin and joint symptoms in SLE?

A

hydroxychloriquine and NSAIDs (unless renal disease)

28
Q

What other medications can be used for SLE?

A
  1. Azathioprine, methotrexate, mycophenolate as steroid sparing agents
  2. topical steroids (skin flares)
  3. Belimuab or rituximab
29
Q

What therapy is used for lupus nephritis?

A

induction therapy

30
Q

What are possible complications for SLE?

A
  1. Anaemia
  2. Leukopenia
  3. Thrombocytopenia
  4. Corticosteroid cataracts/osteoperosis
  5. Pericarditis
  6. Myocarditis
  7. Endocarditis
  8. Depression
    Etc
31
Q

What is the prognosis for SLE?

A

80% survival; at 15 years, increased LT risk of CVD and osteoperosis

32
Q

What type of reaction is SLE?

A

Type 3 hypersensitivity reaction

33
Q

What drugs can cause SLE?

A
  1. Sulfalazine
  2. Hydralazine
  3. Isoniazid
  4. Procainamide
  5. Penicillamine
34
Q

What is a discoid rash?

A

erythematous circular raised patches with adherent keratotoic scaling and follicular plugging: atrophic scarring may occur

35
Q

What would C3 and C4 show?

A

C3 and C4 depletion

36
Q

What would renal biopsy show in SLE?

A

Lupus nephritis (nephritic or nephrotic syndrome

37
Q

What would indicate drug induced lupus?

A

Anti-histone

38
Q

What is the medication used for maintenace?

A

NSAIDs and hydroxychloroquine for joint and skin symptoms

39
Q

What is the medication is used for mild flare?

A

low dose steroids

40
Q

What is the medication is used for moderate flare?

A

DMARDS or mycophenolate

41
Q

What is the medication used for severe flare?

A
  1. high dose steroids
  2. mycophenolate
  3. cyclophosphamide
  4. rituximab
42
Q

What is gene genetic marker?

A

HLA-D3

Z Year3 MSK Conditions (26 decks)

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