SLE Flashcards
Pathophysiology
Development of autoantibodies against DNA
Delayed/deficit clearance of apoptotic cells –> release of DNA into the circulation –> immune reponse
Disease is thought to be due to the formation of AB-Ag complexes
Clinical features
Fevers, weight loss, fatigue, myalgias Rashes - malar, discoid, photosensitive Arthritis - hands, wrists, feet and knees Raynauds Oral ulceration Alopecia Sicca symptoms Serositis Neurological disease Renal disease Haemological disease
Lupus arthritis
Symmetrical
Polyarthritis
Non erosive
Non-deforming unless Jaccouds is present
Diagnostic tests for SLE
ANA ENA DsDNA APL Abs Lupus anticoagulant Cardiolipin Abs Beta 2 glycoprotein 1 Ab
Monitoring tests for SLE
ESR
CRP
C3 and C4 levels
Urine dipstick
Most specific ENA
Anti Smith Abs
SLE CNS disease
Seizures Headache Stroke Transverse myelitis Coma Dementia Ataxia Meningitis Psychiatric disorders Peripheral neuropathy
Renal SLE disease
1 = minimal change disease 2 = mesangial proliferative disease 3 = focal proliferative LN 4 = Diffuse proliferative LN 5 = Membraneous LN 6 = Advanced sclerosing LN
Ethnicity and SLE
African Americans Hispanics Asians - Increased prevalance - Increased severity - Increased renal disease
Management of SLE
Education Sun exposure avoidance Exercise Cease smoking Vitamin D Address CV risk factors Hydroxychloroquine for all Steroids Azathiopurine - except LN class 4 MMF - LN class 4 Cyclophosphamide for renal disease Belimumab
Rare side effect of hydroxychloroquine
Ocular toxicity
What is belimumab?
Anti BAFF
B cell stimulation cytokine
–> inhibits B cell survival and activation
Modest effectiveness
SLE in pregnancy
Disease should be well controlled prior to pregnancy
AZA, prednisone and HCQ safe in pregnancy
What about hormonal therapies and SLE
OCP and HRT relatively safe with SLE
