SLE

Question 1

What type of hypersensitivity reaction is SLE?

Answer 1

Type 3 (antigen-antibody complex deposition)

Question 2

Systemic Lupus erythematosus is a______ s______ i_____

Answer 2

autoimmune systemic inflammation

Question 3

Who is most at risk of SLE?

Answer 3

Females
Afro-Caribbean
20-40 (pre-menopausal)
Certain drugs like isoniazid
HLA B8/ DR2/ DR3

Question 4

What is the pathophysiology of SLE?

Answer 4

Loss of tolerance so variety of autoantibodies made including anti-nuclear antibodies (ANA). Apoptotic debris presented to TH2 and stimulates B cell activation.
Immune complexes form which activates the complement system.
Complement system contributes to inflammation and tissue injury.

Question 5

What are symptoms of SLE?

Answer 5

Butterfly rash and photosensitivity
Glomerulonephritis (nephritic syndrome)
Seizures and psychosis
Mouth ulcers
Serositis (inflammation of linings)
Anaemia
Joint Pain
Raynaud’s
Pyrexia (above normal temperature)

Question 6

True or false: ESR and CRP are raised in SLE?

Answer 6

False
Raised ESR
Normal CRP

CRP is produced by liver in response to acute inflammation. SLE is often chronic inflammation

Question 7

What would a urine dipstick show in SLE?

Answer 7

Lots of haematuria
Some proteinuria
(think nephritic syndrome)

Question 8

True or false: in SLE there are both ANA antibodies and Anti dsDNA antibodies present

Answer 8

True
In most cases both are present and Anti Double-stranded DNA is used to monitor progression

Question 9

What happens to the level of C3 and C4 (complement proteins) in SLE?

Answer 9

Decrease
(immune complexes activate complement system leading to consumption of C3 and C4)

Question 10

How do you treat SLE?

Answer 10

Corticosteroid + Hydroxychloroquine + NSAIDs

(aim to taper off other drugs so only on hydroxychloroquine once stable)

Avoid sunlight