SLE

Question 1

To what ratio does SLE affect men and women?

Answer 1

Women: men 10:1

Question 2

Which minorities are particularly at risk?

Answer 2

Afro-carribean + asian

Question 3

What are the early clinical manifestations?

Answer 3

Renal disease + infection

Question 4

What are the late clinical manifestations?

Answer 4

Cardiovascular

Question 5

What are the comments features?

Answer 5

•  Rash (malar vs discoid)
•  PhotosensiIvity
•  Hair loss
•  Mouth ulcers
•  FaIgue
•  Joint pain – deformiIes are unusual but can
occur (Jaccoud’s)
•  Not life-threatening but not trivial

Question 6

What are the more serious features?

Answer 6

1) Renal disease
2) Blood disorders
3) CNS involvement
4) Cardiac and chest

Question 7

What are the features of renal disease in SLE?

Answer 7

• Earliest sign is usually asymptomaIc proteinuria.
• Some present with nephrotic syndrome
• Some have hypertension and haematuria
• Key is early diagnosis and biopsy leading to appropriate treatment
• Dialysis and transplant are far less common now in adherent patients

Question 8

What are the features of blood disorders in SLE?

Answer 8

• ITP – may predate the SLE
• Very low platelets – steroids and someImes splenectomy
• HaemolyIc anaemia – high dose steroids
• Lymphopaenia – common but not usually
dangerous
• Neutropaenia – rarer but more dangerous

Question 9

How does SLE affect the CNS?

Answer 9

• Wide range of possible presentaIons
• ACR has listed 19 possible categories
• Often very difficult to tell whether the symptoms are due to SLE or not
• Ordinary MRI often not helpful
• New types of scan may be helpful
• Remember that time to recovery may be prolonged

Question 10

How does SLE affect the chest and heart?

Answer 10

• Pleurisy and pericardiIs are often painful but self-limiting
• Myocarditis is more dangerous
• Coronary artery disease and stroke are
increasingly important in SLE
• Remember antiphospholipid syndrome (20-30% of paIents with SLE have aPL)

Question 11

How does CVD present in SLE?

Answer 11

• 25% of deaths in a recent mortality study were due to CVD.
• Manzi showed 50-fold increased risk of CAD in women with lupus aged 35-44.
• Imaging studies show increased rate of vascular abnormaliIes in patients with SLE.
• What should we do about it?

Question 12

Does SLE affect your fertility and pregnancy?

Answer 12

• FerIlity is not a major problem except in people who are amenorrheoic a`er cyclophosphamide.
• Women with APS have increased risk of miscarriage
• Women with anI-Ro/anI-La have 2% chance of fetal
heart block
• Some women flare during pregnancy
• Difficulty in disInguishing lupus nephriIs from pre- eclampsia

Question 13

What can a patient with SLE expect?

Answer 13

• Long-term regular follow-up in specialist clinic.
• Monitoring of blood pressure and urine
• Persistent irritaIng symptoms not needing steroids/ immunosuppression
• If major organ involvement – high dose steroids plus immunosuppression
• AhenIon to CVD risk at a younger age
• Advice and close monitoring in pregnancy

Question 14

Why is SLE considered an autoimmune disease?

Answer 14

• Presence of Ig and complement in the inflamed Issues.
• Complement depleIon in blood
• AutoanIbodies in blood
• Murine models of the disease
• Response to immunosuppressants.