SLE

Question 1

A 36 year old woman with SLE is hospitalised for investigation of declining renal function. She complains of pleuritic retrosternal chest pain. How would you assess her?

Answer 1

Impression
Lupus nephritis is major concern (largest cause of mortality in lupus patients) and potential complication of pericarditis/pleurisy given the pleuritic retro-sternal chest pain.

DDx;
- other cause of renal failure
- infective cause of pericarditis/pleurisy

Other autoimmune;
- RA
- Systemic sclerosis
- polymyocitis, dermatomyo

Question 2

Assessment

Answer 2

Assessment
- Hx of SLE, when diagnosed, how well controlled, medication regimen
- details of renal failure, treatment for
sx
RASH OR PAIN
Rash (malar, discoid, arthritis, serositis, haematological (cytopenias), oral/nasal ulcers, renal nephritis, photosensitivity, autoimmunity, immunological markers, neurological manifestations [cognitive impairment, headaches, psychosis.

Question 3

Exam

Answer 3

Exam
- cardioresp exam to differentiate pericarditis from pleurisy
- pericarditis worsens on lying down and improves with sitting forwards, worse on inspiration
- ECG changes in pericarditis

• pericardial friction rub heard on auscultation

Question 4

Investigations

Answer 4

investigations
- Clinical and biochemical criteria for the diagnosis of SLE

For current presenting symptoms;
- lung functioning test
- ecg
- ECHO
- renal function test

Question 5

Management

Answer 5

Management

Pharmacological
- NSAIDs
- Glucocorticoids
- Hydroxychloroquine
- Biologics