SLE Flashcards
What does SLE stand for?
Systemic lupus erythematosus
Who most commonly gets SLE?
Asians, black, latino females
True or False
There is no genetic link with SLE.
False.
What hormonal factors need to be considered with the aetiology of lupus?
High oestrogen exposure e.g. early menarche, on HRT.
What environmental factors may trigger SLE?
Viruses e.g. EBV
UV light (rashes exacerbated by UV)
Silica dust in cigarette smoke, cleaning products and cement.
What is the pathogenesis of SLE?
Increased apoptosis due to loss of primary immune regulation.
B and T cells stimulated by release of nuclear material from apoptotic cells.
Autoantibodies produced.
What is the cellular pathway that causes damage to endothelial cells?
Immune complexes are deposited into wall of blood vessel.
Neutrophils are attracted due to complement activation.
Enzymes from neutrophils cause damage to basement membrane.
What makes SLE hard to diagnose?
Appears with constitutional symptoms i.e. fever, malaise, fatigue, wt loss, anorexia
What mucocutaneous features are common in SLE?
Photosensitivity
Malar rash- butterfly pattern
Alopecia
Raynauds
What MSK features does SLE have?
RA
Myopathy
What pulmonary features does SLE have?
Pleurisy
Pulmonary hypertension
Lung fibrosis
Infarct
What cardiac features does SLE have?
Pericarditis
cardiomyopathy
Libman-Sachs endocarditis
What is Libman-Sachs endocarditis?
Non-bacterial.
The vegetation in the mitral valve is formed of WBCs.
Glomerulonephritis is a sign of SLE.
How does this present?
Proteinuria
Urine RBC
Hypertension
Renal failure
What neurological features are involved with SLE?
Depression
Migrane headache
TIA/stroke
What haematological features does SLE have?
Lymphadenopathy
Anaemia
Thrombocytopenia
Why do SLE sufferers have a susceptibility to infection?
Low complement
Impaired cell mediated immunity
Steroids and other immunosuppressants
What investigations would you do if you suspected SLE?
FBC
Renal function tests
ANA antibodies
Anti-double stranded DNA antibodies
In what other conditions is ANA positive?
RA
HIV
Hep C
Why is anti-double stranded DNA a good way to track SLE activity?
It rises with severity of disease and can be followed.
What is the management plan for SLE sufferers?
Counselling
regular monitoring
Avoiding sun-exposure
Pregnancy issues????
What drug treatment can be given for SLE?
NSAIDs
Anti-malarials e.g. hydroxychloroquine. Mostly for constitutional symptoms.
When would small doses of steroids be given to manage SLE?
Skin rashes and RA and serositis.
Not a long term solution and never used alone.
What immunosuppressives can be used to treat SLE?
Azathioprine
Methotrexate
Cyclophosphamide -IV drug and toxic
What biologics can be used to treat SLE?
Rituximab
Belimumab
What is the link with complement and SLE?
As disease gets worse, complement levels (especially c3,c4) gets lower
Why is pregnancy a difficult issue with SLE sufferers?
Anti Ro can cross placenta and baby may need to be paced on delivery
Lupus flares during pregnancy
Need stable disease for a year before contemplating pregnancy
If renal involvement then pre-eclampsia risk is much higher
Some drugs are unsuitable for pregnancy
