SLE

Question 1

What is systemic lupus erythematosus (SLE)?

Answer 1

A multisystemic autoimmune disorder in which autoantibodies form immune complexes.

Question 2

Is SLE more common in men or women?

Answer 2

Women (x10)

Question 3

Give some predisposing factors and triggers linked to SLE

Answer 3

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

Question 4

Pathophysiology of SLE?

Answer 4

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

Question 5

Give some clinical features of SLE

Answer 5

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

Question 6

What rash is typically seen in SLE?

Answer 6

Malar/butterfly rash: A fixed erythematous rash of the cheek bones that spares the nasolabial folds.

Question 7

What are some organ specific complications of SLE?

Answer 7

1) Renal:
- lupus nephritis

2) Respiratory:
- pleuritis
- pneumonitis
- pulmonary emboli

3) CVS:
- pericarditis
- Raynaud’s phenomenon
- endocarditis
- atherosclerosis

4) NeuropsychiatricL
- headache/migraine
- seizures
- psychosis

Question 8

What are 3 other autoimmune conditions that SLE can be associated with?

Answer 8

1) Anti-phospholipid syndrome

2) Sjogren’s syndrome

3) Autoimmune thyroid disease

Question 9

What bloods are indicated in SLE?

Answer 9

1) FBC

2) ESR & CRP

3) ANA

4) U&Es

Question 10

FBC results in SLE?

Answer 10

• normochromic normocytic anaemia is common
• leucopenia
• thrombocytopenia

Question 11

ESR & CRP in SLE?

Answer 11

ESR raised with a NORMAL CRP

If CRP raised, think infection or arthritis

Question 12

What is arguably the most important test in SLE?

Answer 12

ANA

Question 13

What is a key differential for SLE?

Answer 13

RA

Question 14

Pharmacological mx of SLE?

Answer 14

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)

Question 15

Non-pharmacological mx of SLE?

Answer 15

1) Lifestyle e.g. smoking cessation

2) Sun protection (UV can trigger flares)

3) Psychosocial support

Question 16

How long should disease activity be under control for before women with SLE should get pregnant?

Answer 16

At least 6 months

Question 17

Pregnancy risks of SLE?

Answer 17

Increased risk of miscarriage, pre-eclampsia & preterm birth –> high-risk obstetric care

Question 18

Complications of SLE?

Answer 18

1) Infection

2) Lupus nephritis

3) Osteoporosis

4) Atherosclerosis

5) Malignancy

Question 19

What is lupus nephritis?

Answer 19

A common condition within SLE (60% of patients).

Characterised by a typical NEPHRITIC picture with peripheral oedema and haematuria.

Question 20

What is osteoprosis linked to in SLE?

Answer 20

1) early menopause
2) uncontrolled disease activity
3) disease prevention and treatment factors e.g. reduced sun exposure and glucocorticoids

Question 21

What type of hypersensitivity reaction is seen in SLE?

Answer 21

Type III

Question 22

What does the malar rash appear following?

Answer 22

Sun exposure

Question 23

What skin manifestations may be seen in SLE? (3)

Answer 23

1) Malar rash

2) Discoid rash - chronic rash in sun exposed areas that are plaque like

3) General photosensitivity of skin (sun exposed areas)

Question 24

What mucosal manifestations may be seen in SLE? (1)

Answer 24

1) Ulcers (mouth & nose)

Question 25

What serosal manifestations may be seen in SLE? (2)

Answer 25

1) pleuritis

2) pericarditis

Question 26

What joint manifestations may be seen in SLE? (2)

Answer 26

1) Arthritis (2 or more joints to meet criteria)

2) Arthralgia

Question 27

What haematological manifestations may be seen in SLE? (3)

Answer 27

1) Anaemia

2) Thrombocytopenia

3) Leukopenia

Question 28

What antibodies may be seen in SLE? (4)

Answer 28

1) ANA (sensitive but not specific)

2) Anti-smith

3) Anti-dsDNA

4) Anti-phospholipid