SLE Flashcards
What is systemic lupus erythematosus (SLE)?
SLE is an inflammatory autoimmune connective tissue disorder that affects multiple organs and systems. It is characterized by the typical red malar rash across the face and a relapsing-remitting course.
Who is most commonly affected by systemic lupus erythematosus (SLE)?
SLE is more common in:
* Women
* People of Asian, African, Caribbean, and Hispanic ethnicity
* Young to middle-aged adults
What are the common complications of systemic lupus erythematosus (SLE)?
Significant complications include:
* Cardiovascular disease
* Infection
* Nephritis
* Shortened life expectancy, although this is mitigated with effective management.
What is the pathophysiology of systemic lupus erythematosus (SLE)?
SLE is characterized by the presence of anti-nuclear antibodies (ANA), which are autoantibodies against proteins within the cell nucleus, generating a chronic inflammatory response.
What are the common symptoms of systemic lupus erythematosus (SLE)?
Common symptoms include:
* Fatigue
* Weight loss
* Arthralgia (joint pain)
* Non-erosive arthritis
* Myalgia (muscle pain)
* Fever
* Photosensitive malar rash
* Lymphadenopathy
* Splenomegaly
* Shortness of breath
* Pleuritic chest pain
* Mouth ulcers
* Hair loss
* Raynaud’s phenomenon
* Oedema (due to nephritis)
What is the typical appearance of the malar rash in SLE?
The malar rash is butterfly-shaped, affecting the nose and cheeks. It is photosensitive and worsens with sunlight exposure.
What investigations are useful in diagnosing systemic lupus erythematosus (SLE)?
Useful investigations include:
* Autoantibodies (ANA, anti-dsDNA)
* Full blood count (may show anaemia, leukopenia, and thrombocytopenia)
* CRP and ESR (may be elevated in active disease)
* C3 and C4 (may be decreased in active disease)
* Urinalysis (proteinuria in lupus nephritis)
* Renal biopsy for lupus nephritis
What are the autoantibodies associated with systemic lupus erythematosus (SLE)?
Autoantibodies include:
* ANA (anti-nuclear antibodies): Positive in 85% of cases
* Anti-dsDNA: Highly specific to SLE and useful for monitoring disease activity
* Extractable nuclear antigen panel: Includes anti-Sm, anti-centromere, anti-Ro, anti-La, anti-Scl-70, anti-Jo-1
* Antiphospholipid antibodies: May lead to antiphospholipid syndrome and increase risk of venous thromboembolism
What is the European League Against Rheumatism (EULAR) / American College of Rheumatology (ACR) criteria used for?
The EULAR/ACR criteria (2019) is used for diagnosing systemic lupus erythematosus (SLE) based on clinical features and autoantibodies.
What are some key complications of systemic lupus erythematosus (SLE)?
Key complications include:
* Cardiovascular disease (hypertension, coronary artery disease)
* Infections (due to the disease and immunosuppressive drugs)
* Anaemia, leukopenia, and thrombocytopenia
* Pericarditis and pleuritis
* Interstitial lung disease
* Lupus nephritis
* Neuropsychiatric manifestations (optic neuritis, transverse myelitis, psychosis)
* Recurrent miscarriage and other pregnancy complications
* Venous thromboembolism associated with antiphospholipid syndrome
What are the first-line treatments for systemic lupus erythematosus (SLE)?
First-line treatments include:
* Hydroxychloroquine
* NSAIDs
* Steroids (e.g., prednisolone)
What are the second-line treatments for more severe or resistant SLE?
Second-line treatments include:
* DMARDs (e.g., methotrexate, mycophenolate mofetil, cyclophosphamide)
* Biological therapies (e.g., Rituximab, Belimumab)
What are the biological therapies used in the treatment of systemic lupus erythematosus (SLE)?
Biological therapies include:
* Rituximab: A monoclonal antibody that targets the CD20 protein on B cells
* Belimumab: A monoclonal antibody that targets B-cell activating factor
What lifestyle modifications are important in managing systemic lupus erythematosus (SLE)?
Sun avoidance and the use of sun protection (e.g., sunscreen) are essential in managing the photosensitive malar rash.
