SLE

Question 1

ACR criteria for diagnosis

Answer 1

4 or more of:

Malar rash
Discoid rash
Photosensitivity
Mouth ulcers
Non-erosive arthropathy
Serositis (pleuritis, pericarditis, effusions)
Chronic glomerulonephritis (proteinuria etc)
Haematological disorder (leucipaenia, lymphopenia, DVT/PE, miscarriages)
ANA
Other ones eg anti-Sm (Smith), anti-dsDNA, anti phospholipid
Neurological involvement - seizures, psychosis, mononeuritis multiplex, transverse myelitis, GBS

Question 2

Examination

Answer 2

Arthritis not deforming unless cross over. Jaccouds arthropathy male fingers appear to have deformities but it reverses when closed into fist

Mucocutaneous 
- malar rash
Discoid rash
Photosensitivity
Scarring alopecia
Mouth ulcers
Livedo reticularis

Cardiac valve abnormalities due to Libman-sacks endocarditis

Hypertension

Urinalysis
Nephrotic syndrome
eSRF/ dialysis pt/ transplant

Evidence thrombotic events

Neurological abnormalities

Question 3

Sjögren’s syndrome

Answer 3

Often secondary to other CTD eg RA or SLE

Dry eyes, dry mouth, enlarged parotids

Schirmers rest positive - sterile filter paper 5mm width under each eyelid 5 mins. Normally >15mm wet

ENA antibodies eg anti-Ro or anti-La
Also RhF, anti-dsDNA

40 fold increase incidence of lymphoma

Question 4

Investogatiosn

Answer 4

Urinalysis/ MSU
FBC
CRP/ESR
ANA
DsDNA
ENA
C3/c4
Anti-phospholipid
CK
CXR

Question 5

Treatment

Answer 5

Steroids
Azathiaprine
IV cyclophosphamide
Methotrexate
Mycophenalate

Biological
- rituximab

IV Ig for serious flares esp neuro

Plasmapheresis

Anticoagulation for secondary antiphospholipid

ACE-I for renal disease

Statin as risk of CAD