SLE

Question 1

Pathology?

Answer 1

• Increased cell death and impaired clearance of cell debris
• Mediated by circulating immune complexes which form in small blood vessels causing inflammation and complement activation
• Complexes deposited in basement membranes of skin and lungs

Question 2

Prevalence?

Answer 2

• Increased in black people in US and UK but not in black people in Africa
• 90% cases are in women typically 20-30

Question 3

Consitutional symptoms?

Answer 3

Fever
Fatigue
Weight loss

Question 4

MSK symptoms?

Answer 4

Arthralgia
Myalgia
Inflammatory arthritis

Question 5

Muco-cutaneous symptoms?

Answer 5

Malar rash
Photosensitivity
Oral/nasal ulceration
Raynauds
Alopecia

Question 6

Renal symptoms?

Answer 6

Lupus nephritis

Question 7

Respiratory symptoms?

Answer 7

Pleurisy
Pleural effusion
PE
Pneumonitis
Pulmonary hypertension
Interstitial lung disease

Question 8

Haematological symptoms?

Answer 8

Thrombocytopenia
Leukopenia
Anaemia

Question 9

Neurological symptoms?

Answer 9

Headache
Seizures
Meningitis
Psychosis

Question 10

Cardiovascular symptoms?

Answer 10

Pericarditis
Pericardial effusion
Sterile endocarditis

Question 11

Investigations?

Answer 11

No single diagnostic test
FBC = anaemia, leukopenia, thrombocytopenia
ANA = not specific
Anti-dsDNA = specific but varies with disease activity
Urinalysis for glomerulonephritis
Imaging for chest involvement

Question 12

Management for skin involvement and arthralgia?

Answer 12

NSAIDs
Hydroxychloroquine
Topical steroids

Question 13

Management for inflammatory arthritis or organ involvement?

Answer 13

Immunosupression

• azathioprine
• corticosteroids

Question 14

Management for severe organ involvement?

Answer 14

IV steroids

Cyclophosphamide

Question 15

Management for unresponsive cases?

Answer 15

IV immunoglobulin

Rituximab