SLE Flashcards
What is SLE?
Auto-immune disease where multiple auto-antibodies are made against many auto-antigens
Results in inflammation, immune complex deposition, complement activation
Who gets SLE?
HLA types
Women
African-Caribbean, Asian
HLA B8, DR2, DR3
Diagnostic criteria for SLE?
Need 4 of 11
MD SOAP BRAIN
Malar flash
Discoid rasg
Serositis: pericarditis, pleuritis
Oral ulcers
ANA +ve
Photosensitivty
Blood: haemolytic, thrombocytopenia, leukopenia
Renal: proteinuria
Arthritis
Immune: anti-dsDNA, anti-SM, Rheum factor, anti-phospholipid
Neuro: seizures, psychosis
Which antibodies are found in SLE?
ANA (anti-nucleic antibody)
anti-dsDNA anti-SM Rheumatoid factor Anti-histone (in drug induced) Anti-phospholipid antibodies - anti-cardiolypin - lupus anticoagulant - anti B2 glycoprotein
Which other autoimmune conditions is SLE associated with?
Sjorgen’s
Autoimmune thyroid disease
How is SLE disease activity monitored?
- anti-dsDNA antibody titres
- complement C3 and C4 will be low as they’ve been consumed
- ESR
Also look at urine (protein), BP, bloods
What happens to inflammatory markers in SLE?
ESR raised
CRP normal
What non-immune things can cause SLE?
UV light
Viruses: EBV
Drug induced lupus:
- phenytoin
- OCP
- Biologics
- Chlorpromazine
- Methyldopa
- Hydralazine
- Isoniazid
Which autoantibody is seen mainly in drug induced SLE?
Anti-histone
What counts as a severe SLE flare up?
Haemolytic anaemia
Nephritis
Severe pericarditis
CNS disease
Management of a severe SLE flare up?
Urgent IV cyclophosphamide
High dose prednisolone
Management of SLE? (maintenance)
NSAIDs
DMARDs: hydroxychloroquine, methotrexate, azothioprine
Low dose steroids
Biologics: belimumab, rituximab
Side effect of hydroxychloroquine?
Irreversible retinopathy
Which conditions does SLE increase risk of?
Cardiovascular disease
Osteoporosis
How does SLE affect pregnancy?
Increased risk of: Premature delivery Intra-uterine growth restriction Pre-eclampsia Thrombosis, also in puerpium Early pregnancy loss
What is anti-phospholipid syndrome? Causes?
Anti-phospholipid antibodies causing issues
This can occur as a primary disease or can be associated with SLE
What are the anti-phosphlipid antibodies?
Anti-cardiolypin
Lupus anticoagulant
Anti-B2 glycoprotein
What issues does anti-phospholipid cause?
Management
CLOT
Coagulation defect
Livedo reticularis
Obstetric (recurrent miscarriage)
Thrombocytopenia, thrombotic tendencies
Treat with low dose aspirin
Or warfarin if recurrent clots
What is the rash that is seen in SLE and other connective tissue diseases that looks like a lace pattern?
Livedo reticularis
