SLE

Question 1

What does SLE stand for?

Answer 1

Systemic lupus erythematosus

Question 2

Who most commonly gets SLE?

Answer 2

Asians, black, latino females

Question 3

True or False

There is no genetic link with SLE.

Answer 3

False.

Question 4

What hormonal factors need to be considered with the aetiology of lupus?

Answer 4

High oestrogen exposure e.g. early menarche, on HRT.

Question 5

What environmental factors may trigger SLE?

Answer 5

Viruses e.g. EBV
UV light (rashes exacerbated by UV)
Silica dust in cigarette smoke, cleaning products and cement.

Question 6

What is the pathogenesis of SLE?

Answer 6

Increased apoptosis due to loss of primary immune regulation.
B and T cells stimulated by release of nuclear material from apoptotic cells.
Autoantibodies produced.

Question 7

What is the cellular pathway that causes damage to endothelial cells?

Answer 7

Immune complexes are deposited into wall of blood vessel.
Neutrophils are attracted due to complement activation.
Enzymes from neutrophils cause damage to basement membrane.

Question 8

What makes SLE hard to diagnose?

Answer 8

Appears with constitutional symptoms i.e. fever, malaise, fatigue, wt loss, anorexia

Question 9

What mucocutaneous features are common in SLE?

Answer 9

Photosensitivity
Malar rash- butterfly pattern
Alopecia
Raynauds

Question 10

What MSK features does SLE have?

Answer 10

RA

Myopathy

Question 11

What pulmonary features does SLE have?

Answer 11

Pleurisy
Pulmonary hypertension
Lung fibrosis
Infarct

Question 12

What cardiac features does SLE have?

Answer 12

Pericarditis
cardiomyopathy
Libman-Sachs endocarditis

Question 13

What is Libman-Sachs endocarditis?

Answer 13

Non-bacterial.

The vegetation in the mitral valve is formed of WBCs.

Question 14

Glomerulonephritis is a sign of SLE.

How does this present?

Answer 14

Proteinuria
Urine RBC
Hypertension
Renal failure

Question 15

What neurological features are involved with SLE?

Answer 15

Depression
Migrane headache
TIA/stroke

Question 16

What haematological features does SLE have?

Answer 16

Lymphadenopathy
Anaemia
Thrombocytopenia

Question 17

Why do SLE sufferers have a susceptibility to infection?

Answer 17

Low complement
Impaired cell mediated immunity
Steroids and other immunosuppressants

Question 18

What investigations would you do if you suspected SLE?

Answer 18

FBC
Renal function tests
ANA antibodies
Anti-double stranded DNA antibodies

Question 19

In what other conditions is ANA positive?

Answer 19

RA
HIV
Hep C

Question 20

Why is anti-double stranded DNA a good way to track SLE activity?

Answer 20

It rises with severity of disease and can be followed.

Question 21

What is the management plan for SLE sufferers?

Answer 21

Counselling
regular monitoring
Avoiding sun-exposure
Pregnancy issues????

Question 22

What drug treatment can be given for SLE?

Answer 22

NSAIDs

Anti-malarials e.g. hydroxychloroquine. Mostly for constitutional symptoms.

Question 23

When would small doses of steroids be given to manage SLE?

Answer 23

Skin rashes and RA and serositis.

Not a long term solution and never used alone.

Question 24

What immunosuppressives can be used to treat SLE?

Answer 24

Azathioprine
Methotrexate
Cyclophosphamide -IV drug and toxic

Question 25

What biologics can be used to treat SLE?

Answer 25

Rituximab

Belimumab

Question 26

What is the link with complement and SLE?

Answer 26

As disease gets worse, complement levels (especially c3,c4) gets lower

Question 27

Why is pregnancy a difficult issue with SLE sufferers?

Answer 27

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