SLE

Question 1

Who does SLE typically affect? (3)

Answer 1

-Females
-Afro Caribbean
-20-40 (premenopausal)

Question 2

Which combination of v. specific and v. sensitive tests are used as essentially diagnostic for SLE?

Answer 2

ANA - sensitive
anti dsDNA / anti smith - specific

Question 3

What type of hypersensitivity reaction is systemic lupus erythmatosus? (SLE)

Answer 3

Hypersensitivity T3 reaction (A-A complex depositon)
= autoimmune systemic inflammation

Question 4

Treatment of SLE? (4)

Answer 4

-Lifestyle changes (less sunlight or UV protection + stop the triggering drugs)

• Drugs:
  1) Corticosteroids (main) IN A FLARE
  2) + hydroxychloroquinine - IN MILDER SYMPTOMS
  3) + NSAIDS
  (+ azathioprine, mycophenolate if severe (cytotoxic))

Question 5

Treatment for SLE once stable?

Answer 5

only hydroxychloroquine

Question 6

Symptoms of SLE? (5)

Answer 6

Key:
-butterfly rash
-glomerulonephritis
-mouth ulcers
-joint pain
-raynauds

Extras:
- photosensitivity
- seizures + psychosis
- anaemia
- pyrexia
- serositis (pleural/pericardial inflammation of lungs)
- pericarditis

Question 7

Pathophysiology of SLE? (3)

Answer 7

UV + other triggers - cause apoptosis - fragments of nuclear antigens from cell - to TH cells -> B cell activation makes antinuclear antibodies -> antigen-antibody complexes - deposition in tissues

Question 7

Risk factors for SLE? (3)

Answer 7

-Female (12x more than males) (90% are women)
-HLAB8/DR2/DR3 + low C4 (null allele)
-drugs (isoniazid)

Question 8

Joint deformations in SLE?

Answer 8

Can look very similar to rheumatoid arthritis but non erosive and less proliferative

Question 9

Investigations to diagnose SLE? (3)

Answer 9

-Bloods -> anaemia, Increase ESR + normal CRP

-Urine dipstick -> haematuria++++ proteinuria++ (NephrItic syndrome)

-Serology:
- ANA Abs (99% of cases)
- Anti ds DNA Ab’s (to monitor progression)
- Decreased C3+C4

Question 10

How to diagnose lupus nephritis?

Answer 10

Crescent formation in histology

Question 11

Haematological features of SLE? (4)

Answer 11

Anaemia (haemolytic, Coombs positive)
Thrombocytopenia
Neutropenia
Lymphopenia

Question 12

Auto antibodies with SLE?

Answer 12

Double stranded DNA antibody is specific to lupus
C4 A null allele

Question 13

C4A null allele

Answer 13

lack of C4 and C3

Question 14

systemic presentation

Answer 14

Question 15

arthiritis in sle

Answer 15

Symmetrical
Less proliferative than RA
Can be deforming
Non-erosive

Question 17

SLE : Neuro-psychiatric Features

Answer 17

Acute inflammatory demyelinating polyradiculopathy
Aseptic meningitis
Autonomic disorder
Cerebrovascular disease
Demyelinating syndrome
Headache
Mononeuropathy (single/multiplex)
Movement disorder (chorea)
Myasthenia gravis
Myelopathy
Cranial neuropathy
Plexopathy
Polyneuropathy
Seizures and seizure disorders
Acute confusional state
Anxiety disorder
Cognitive dysfunction
Mood disorder
Psychosis