SLE

Question 1

What is SLE?

Answer 1

Chronic autoimmune disease with multi-system involvement, mainly joints, skin and serous membrane

Question 2

Common eitology of SLE?

Answer 2

Females between 15 and 44 - reproductive years

Question 3

Pathogenesis of SLE?

Answer 3

UV rays damage cell DNA leading to apoptosis
- macrophages fail to remove apoptotic remnants of cell

Immune cells see these as foreign antigens and B cell tolerance decreases, resulting in excessive autoantibody production

These cause local inflammatory reactions

Question 4

Intra oral presentations of SLE?

Answer 4

Oral ulceration
Erosion of the mucosa
Hyposalivaiton - salivary gland disease
Pigmentation
Burning mouth syndrome

Question 5

2 main types of mucosal lesion in SLE?

Answer 5

Discoid lesion (above)
- area of erythema
- typically painless although can be sensitive to hot / spicy foods
- common on hard palate and lower lip

Non-specific apthous ulcers
- often associated with haematinic deficiency
- painful
- non keratinised tissue often

Question 6

Extra oral features of SLE?

Answer 6

Butterfly rash - across bridge of nose

Anaemia

Arthritis - 80/90% pts

Anxiety / depression

Raynaud’s disease

Photosensitivity - exposure to UV can cause macular or erythematous rash

Nephritis - immune complexes deposited in glomerulus basement membrane, one of the earliest presentations

Question 7

7 clinical domains for diagnosing SLE?

Answer 7

Constitutional - fever and weight loss

Haematological - thrombocytopenia, leukopenia etc

Neuropsychiatric - psychosis, seizure, delirium

Mucocutaneous - discoid lupus, oral ulcers etc

Serosal - pericarditis

MSK - joint involvement

Renal - lupus nephritis

Question 8

Immunologic diagnosis criteria for SLE?

Answer 8

Antiphosphlipid antibodies

Complement proteins - low c3&4

SLE specific - anti-dsDNA

Must positive for ANA too.

Question 9

Tx of SLE?

Answer 9

Always hydroxychloroquine - antimalarial

• addition of oral glucocorticoids
• immunosuppressive agents