SLE

Question 1

Prevalence of SLE in childbearing age

Answer 1

1 in 500

Question 2

Pathophydiology

Answer 2

Unknown
Trigger of UV &/or virus with genetic predisposition
25% concordance with MC twins

Immune complex deposition - inflammation on vascular beds
Polyclonal B cell activation- form ANA
Imparaired T cell regulation & deficiency of complement

Question 3

Dx

Answer 3

SOAP BRAIN MD

Question 4

Prepregnancy counselling

Answer 4

Not ass with reduced fertility 
Assess dx activity
Presence of Anti Ro/ Anti La 
Anti phospholipid antibodies + in 30%
Review meds

Question 5

Meds safe in pregnancy

Answer 5

Steroids
Hydrochloriquine
Azathioprine
Ciclosporin with caution

Question 6

Teratogenic meds’

Answer 6

NSAID after 32 wk - closes duct
Methotrexate- NTD
MYcophenolate mofetil (MMF)
Cyclophosphamide

Question 7

Point prevalence of pulmonary hypertension

Ass mortality in pregnancy

Answer 7

4.2%

Upto 40%

Question 8

Worse maternal and fetal outcomes than without SLE

Answer 8

2-4 fold

Include PET, PTB, FGR, thrombosis

Do not conceive with active disease

Question 9

Anti Ro/Anti La

Answer 9

Cause fetal heart block

Assess 18-20 was then 28 wks with Fetal echo

Question 10

Distinguishing a lupus flare

Answer 10

Hematuria with proteinuria
Increased ds DNA
Decrease in complement levels

Only reliable- Renal biopsy. Not done in pregnancy

Question 11

In presence of Anti Ro/La antibodies

What percentage of fetus affected

Recurrence in subsequent pregnancy

Answer 11

2-3%

Recurrence 16%

Question 12

Drugs with lupus like syndrome

Answer 12

Hydralazine
Procainamide
Quinidine
Isoniazid
Diltiazem
Minocycline

Question 13

FGR

Answer 13

In SLE 25%

With concurrent lupus nephritis- 35%