SLE Flashcards
What is systemic lupus erythematosus (SLE)?
An autoimmune disease characterized by inadequate T cell suppressor activity and increased B cell activity
SLE is a complex multisystem disease with variable presentations and prognosis.
What are the common symptoms and signs of SLE?
SOAP BRAIN mnemonic:
* S - Serositis (pleurisy, pericarditis)
* O - Oral ulcers (usually painless)
* A - Arthritis (small joints nonerosive)
* P - Photosensitivity (malar or discoid rash)
* B - Blood disorders (low WCC, lymphopenia, thrombocytopenia, hemolytic anemia)
* R - Renal involvement (glomerulonephritis)
* A - Autoantibodies (ANA positive in >90% cases)
* I - Neurologic issues (seizures , refractory headachesor psychosis)
The mnemonic helps recall the major clinical features of lupus.
What is the significance of antinuclear antibodies (ANA) in SLE?
95% of patients are antinuclear antibody positive
ANA positivity is a hallmark of SLE and indicates an autoimmune process.
What laboratory findings are common in SLE?
Common findings include:
* Raised ESR or plasma viscosity
* Anemia and leukopenia
* Anti-Ro and Anti-La antibodies
* Rising anti-dsDNA titre with disease activity
* Decreasing C3 and C4 with disease activity
* Urinalysis vital for detecting renal disease
- Antiphospholipid antibodies increase the risk of prnancy loss and thrombosis
- skin/renal biopsy
These findings assist in diagnosing and monitoring the disease.
What is a key lifestyle recommendation for patients with SLE?
Sun protection
UV light triggers SLE by altering DNA structure in the dermis, making it more immunogenic.
Which medications are commonly used to treat SLE?
Commonly used medications include:
* Hydroxychloroquine helpful for rash and arthralgia
* Mycophenolate mofetil
* Azathioprine
* Rituximab
* Short courses of prednisolone for flares
These medications help manage symptoms and prevent flares.
True or False: SLE is more common in men than in women.
False
Lupus is 9 times more common in women.
What age group has the peak onset for SLE?
Early adulthood
This is when most patients are diagnosed with SLE.
Fill in the blank: Estradiol may prolong the life of _______ lymphocytes.
[autoreactive B and T]
Estrogens are thought to be permissive for autoimmunity.
What is a simple diagnostic clue for SLE?
Full blood count (FBC) is abnormal in most patients
An abnormal FBC can indicate underlying hematological issues associated with SLE.
What is the relationship between SLE and cardiovascular risk?
SLE is associated with a high cardiovascular disease (CVD) risk
Patients with SLE need to be monitored for cardiovascular health due to increased risk factors.
What are drugs that trigger SLE-like syndrome
- isoniazid
- minocycline
- TNF inhibitors
who does SLE more commonly affected
- women
- asian, african, carribean
- young to middle aged adult
describe the course of SLE
relapsing-remitting: flares of worse symptoms and periods where symptoms settle
what are significant complications of SLE
- CVD
- infection
which antibodies are highly specific to SLE
anti-dsDNA
- this means a positive result suggests SLE rather than other causes
- levels vary with disease activity making them helpful in monitoring disease activity and response to treatment
what investigation can be used to help diagnose and differentiate between specific CT disorders
extractable nuclear antigen panel: looks for antibodies to specific proteins in the cell nucleus
- Anti-Sm (highly specific to SLE but not very sensitive)
- Anti-centromere antibodies (most associated with limited cutaneous systemic sclerosis)
- Anti-Ro and anti-La (most associated with Sjögren’s syndrome)
- Anti-Scl-70 (most associated with systemic sclerosis)
- Anti-Jo-1 (most associated with dermatomyositis)
what antibodies can occur secondary to SLE and what are they associated with
antiphospholipid
- inc risk of VTE
what can anemia in SLE be due to
- anaemia of chronic disease
- autoimmune haemolytic anaemia
- bone marrow suppression by meds or kidney disease
what drugs can be used to treat active disease in SLE (4)
Rituximab
Cyclophosphamide
Mycophenolate mofetil
Belimumab (purpose built for lupus)
What drugs are used for maintenance remission therapy in SLE (3)
Hydroxychloroquine methotraexate
Azathioprine
Leflunomide
how does antiphospholipid syndrome present
CLOT
- Clots
- Livedo reticularis
- Obstetric complications
- Thrombocytopenia
what are key investigation findings of antiphospholipid syndrome
a. antibodies
- anticardiolipin antibodies
- anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
- lupus anticoagulant
b. thrombocytopenia
c. prolonged APTT
what is the management of anti-phospholipid syndrome
- primary prophylaxis: daily low dose aspirin (if ever experienced thromboembolic event)
- secondary: after first event,lifelong warfarin
