SLE Flashcards
Define SLE
Multi-systemic autoimmune inflammatory disease in which autoantibodies to a variety of auto antigens result in the formation and deposition of immune complexes
Which gender is SLE more prevalent in?
F 9:1
In which age group is SLE most common?
Child bearing age
In which ethnic groups is SLE more common?
Afrocaribbean and asian
What are some features for a history of SLE?
Relapsing and remitting history
Constitutional symtoms: fatigue, weight less, five, myalgia
What is A RASH POINts to Medical Diagnosis?
Arthritis Renal - proteinuria and increased BP ANA positive Serositis Haematological: AIHA, decreased WCC and platelets Photosensitivity Oral ulcers Immune phenomenon: anti dsDNA, anti-Sm- anti-phosophlipid Neurological: seizures, psychosis Malar rash Discoid rash
What is the arthritis in SLE like?
Non erosive, involves peripheral joints
Jaccouds: educible deforming arthropathy
What effects of serositis may patients with SLE have?
Pleuritis: pleuritic chest pain, dyspnoea, effusion
Pericarditis: chest pain relieved by leaning forwards
What is a malar rash?
Facial erythema sparing the nasolabial folds
How does a discoid rash occur?
Erythema -> pigmented hyperkeratotic papules -> atrophic depressed lesions
Mainly affects chest and face
What immunology is very specific in SLE?
ANA positive
dsDNA
How can disease activity be monitored for SLE?
Anti sDNA titres
Complement C3 and C4 decrease
Increased ESR
Name some additional investigations that could be done for a patient with SLE?
Bloods: FBC, U&E, CRP, clotting
Urine dip and PCR
What happens in SLE?
Autoantibodies against auto antigens form immune complexes. Inadequate clearance of immune complexes leads to immune responses that cause tissue inflammation and damage
Describe the features of SLE
Often non specific such as malaise, fatigue, myalgia, fever
Organ specific due to inflammation and damage
Lymphodenopathy, weight loss, alopecia, nail fold infarcts, non infective endocarditis (Libman sacks syndrome), raynauds, stroke, retinal exudates
What other autoimmune diseases may SLE be related to
Sjogrens, thyroid disease
What are the three best tests for monitoring disease activity in SLE?
Anti dsDNA antibody titres
Complement decrease C3 and C4
ESR increase
(Urine may show casts or protein if lupus nephritis)
What is drug induced lupus associated with?
Antihistone antibodies
What is normally affected in in drug induced lupus?
Skin and nail
How would you know if it was drug induced lupus?
Symptoms stop once drug is stopped
What drugs can worsen idiopathic SLE?
OCP, sulfonamide
What drugs can induce lupus?
Isoniazid, phenytoin, anti TNF agents etc
What are some general measures in the treatment of SLE?
Sunblock
Hydroxychloroquine
Screen for co-morbidities and medication toxicity
What management is used for maintenance of SLE?
NSAIDs (not if renal disease) and hydroxychloroquine
Azathioprine, methotrexate, mycophenolate as steroid sparing agents
Belimumab (monoclonal antibody)
How to treat a mild flare of SLE with no organ involvement?
hydroxychloroquine or low dose steroids
How to treat a moderate flat of SLE with organ damage?
DMARDs, mycophenolate
How to treat a severe flare of SLE?
High dose steroid, mycophenolate, rituximab, cyclophosphamide
What can antiphospholipid syndrome cause?
Coagulation defect
Livedo reticularis
Obstetric - recurrent miscarriage
Thrombocytopenia
