SLE Flashcards
What is systemic lupus erythematosus (SLE)?
A multisystemic autoimmune disorder in which autoantibodies form immune complexes.
Is SLE more common in men or women?
Women (x10)
Give some predisposing factors and triggers linked to SLE
1) FH (strong hereditary component)
2) UV light exposure (can exacerbate and even trigger onset)
3) Oestrogen (higher prevalence in women during reproductive years)
4) Smoking
5) Viruses e.g. EBV
6) Medications e.g. procainamide, hydralazine, isoniazid
Pathophysiology of SLE?
1) Production of autoantibodies
2) Formation of immune complexes
3) Deposition of immune complexes
4) Activation of innate immunity
5) Inflammation & organ damage e.g. immune complex deposition leads to glomerulonephritis
6) Dysregulation of adaptive immunity
7) Vascular & endothelial dysfunction
Give some clinical features of SLE
1) Malar/ butterfly rash
2) Photosensitivity
3) Arthralgia & arthritis
4) Constitutional: weight loss, fever, malaise
5) Mouth ulcers
6) Alopecia (non-scarring)
7) Discoid erythematosus
What rash is typically seen in SLE?
Malar/butterfly rash: A fixed erythematous rash of the cheek bones that spares the nasolabial folds.
What are some organ specific complications of SLE?
1) Renal:
- lupus nephritis
2) Respiratory:
- pleuritis
- pneumonitis
- pulmonary emboli
3) CVS:
- pericarditis
- Raynaud’s phenomenon
- endocarditis
- atherosclerosis
4) NeuropsychiatricL
- headache/migraine
- seizures
- psychosis
What are 3 other autoimmune conditions that SLE can be associated with?
1) Anti-phospholipid syndrome
2) Sjogren’s syndrome
3) Autoimmune thyroid disease
What bloods are indicated in SLE?
1) FBC
2) ESR & CRP
3) ANA
4) U&Es
FBC results in SLE?
- normochromic normocytic anaemia is common
- leucopenia
- thrombocytopenia
ESR & CRP in SLE?
ESR raised with a NORMAL CRP
If CRP raised, think infection or arthritis
What is arguably the most important test in SLE?
ANA
What is a key differential for SLE?
RA
Pharmacological mx of SLE?
1) NSAIDs (for joint or serosal inflammation)
2) Hydroxychloroquine (recommended for all SLE patients unless contraindicated)
3) Prednisolone (for acute flares & severe disease)
4) Immunosuppressants (moderate to severe disease)
Non-pharmacological mx of SLE?
1) Lifestyle e.g. smoking cessation
2) Sun protection (UV can trigger flares)
3) Psychosocial support
How long should disease activity be under control for before women with SLE should get pregnant?
At least 6 months
Pregnancy risks of SLE?
Increased risk of miscarriage, pre-eclampsia & preterm birth –> high-risk obstetric care
Complications of SLE?
1) Infection
2) Lupus nephritis
3) Osteoporosis
4) Atherosclerosis
5) Malignancy
What is lupus nephritis?
A common condition within SLE (60% of patients).
Characterised by a typical NEPHRITIC picture with peripheral oedema and haematuria.
What is osteoprosis linked to in SLE?
1) early menopause
2) uncontrolled disease activity
3) disease prevention and treatment factors e.g. reduced sun exposure and glucocorticoids
What type of hypersensitivity reaction is seen in SLE?
Type III
What does the malar rash appear following?
Sun exposure
What skin manifestations may be seen in SLE? (3)
1) Malar rash
2) Discoid rash - chronic rash in sun exposed areas that are plaque like
3) General photosensitivity of skin (sun exposed areas)
What mucosal manifestations may be seen in SLE? (1)
1) Ulcers (mouth & nose)
What serosal manifestations may be seen in SLE? (2)
1) pleuritis
2) pericarditis
What joint manifestations may be seen in SLE? (2)
1) Arthritis (2 or more joints to meet criteria)
2) Arthralgia
What haematological manifestations may be seen in SLE? (3)
1) Anaemia
2) Thrombocytopenia
3) Leukopenia
What antibodies may be seen in SLE? (4)
1) ANA (sensitive but not specific)
2) Anti-smith
3) Anti-dsDNA
4) Anti-phospholipid
