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MSK LCRS > SLE > Flashcards

SLE Flashcards

1
Q

Which six diseases contribute to the spectrum of autoimmune connective diseases?

A 
Rheumatoid arthritis 
SLE
Dermatomyositis 
Polymyositis
System sclerosis 
Sjogren's syndrome
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2
Q

What is Sjogren’s syndrome?

A

Autoimmune attack against moisture production aka dry mouth and dry eyes

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3
Q

Describe the typical presentation of SLE

A 
Malaise
Fatigue
Fever
Weight Loss
Lymphadenopathy
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4
Q

What are the specific features of SLE presentation?

A

Butterfly rash (malar rash)
Alopecia
Arthralgia
Raynaud’s phenomenon

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5
Q

What other organs may be affected in SLE?

A

Kidney
CNS
Heart
Lungs

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6
Q

Describe the cardiovascular complications of SLE

A

Accelerated atherosclerosis
Vasculitis
MI

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7
Q

How many of the 11 criteria does someone have to meet to have SLE?

A

4 out of 11

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8
Q

What are the criteria for an SLE diagnosis?

A 
Malar rash
Discoid rash 
Photosensitivity
Oral ulcers
Arthritis 
Serositis
Renal disorder 
Neurological disorder
Haematological disorder 
Immunologic disorder  e.g. anti-dsDNA Abs
Antinuclear antibody in raised titre
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9
Q

What renal disorders may be associated with SLE?

A

Proteinuria

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10
Q

What neurological disorders may be associated with SLE?

A

Seizures

Psychosis

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11
Q

What are the two types of rash associated with SLE?

A

Discoid rash

Malar rash

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12
Q

What is serositis?

A

Inflammation of a serous membrane

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13
Q

Give two examples of serositis associated with SLE

A

Pleuritis

Pericarditis

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14
Q

Briefly describe the process of autoantibody production in SLE

A

Abnormal clearance of apoptotic cell material
Presentation of self antigen by dendritic cells to B cells
Activation of B cells, Ig class switching and affinity mutation
IgG autoantibody production
Immune complexes produced

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15
Q

Which cell and antibody is mainly implicit in SLE?

A

B cells, IgG

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16
Q

What is the effect of autoantibody production?

A

Complement activation
Cytokine generation
End organ damage

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17
Q

Describe 3 common laboratory tests done for SLE

A

ANA
Anti-dsDNA and Anti-Sm
Anti-Rho and/or anti-La

18
Q

What are the four patterns seen in positive ANA?

A

Homogenous
Speckled
Nucleolar
Centromere

19
Q

Which ANA pattern correlates to antibodies against DNA?

A

Homogenous ANA

20
Q

Which does a speckled ANA pattern show?

A 
Antibodies against:
Ro
La
Sm
RNP
21
Q

What does a nucleolar ANA pattern show?

A

Antibodies against topoisomerase

22
Q

What does a nucleolar ANA pattern correlate with clinically?

A

Scleroderma

23
Q

What does a centromere ANA pattern correlate with?

A

Some cutaneous scleroderma involvement

24
Q

Compare the specificities of ANA and anti-dsDNA

A

ANA - non specific

Anti-dsDNA - more specific, less sensitive

25
Q

What is specificity?

A

Ability for a test to correctly pick up when someone doesn’t have the disease (true negative)

26
Q

What is sensitivity?

A

Ability for a test to correctly pick up a disease (true positive)

27
Q

What other markers are picked up in lab tests for SLE?

A

Increased complement consumption
Anti-cardiolipin antibodies
Lupus anticoagulant
Beta-1 glycoprotein

28
Q

What haematological features are seen in SLE?

A 
Lymphopenia 
Normochromic anaemia
Leukopenia 
AIHA
Thrombocytopenia
29
Q

What renal markers are seen in SLE?

A

Proteinuria
Haematuria
Active urinary sediment

30
Q

How do you assess the severity of SLE?

A

Identify the pattern of organ involvement
Monitor function of these affected organs e.g. lung function tests, echocardiography
Identify pattern of autoantibodies expressed

31
Q

Watching out for which clinical features will help to pre-empt severe attacks?

A 
Weight loss
Fatigue
Malaise
Hair loss
Rash
32
Q

Watching out for which laboratory features will help to pre-empt severe attacks?

A

ESR
Increased complement consumption
Increased anti-dsDNA

33
Q

Which lab markers are poor indicators of an SLE attack?

A

ANA

CRP

34
Q

How do you classify the severity of SLE?

A

Mild - join/skin involvement
Moderate - inflammation of organs
Severe - severe inflammation in vital organs incl lungs, kidney, CNS and heart

35
Q

What is the first line of treatment for MILD SLE?

A

Paracetamol/NSAIDs
Hydroxychloroquine
Topical corticosteroids

36
Q

What must you do whilst prescribing paracetamol or NSAIDs?

A

Monitor renal function

37
Q

When would you give hydroxychloroquine in mild SLE?

A

If there’s any arthropathy or cutaneous manifestations

38
Q

What is the indication for prescribing corticosteroids in moderate disease?

A

If NSAIDs and hydroxychloroquine didn’t work

Organ involvement/life threatening disease

39
Q

Which drugs would you give for severe SLE?

A

Azathioprine
Cyclophosphamide
Mycophenolate mofetil
RItuximab

40
Q

What is the bimodal mortality pattern of SLE?

A

Early active lupus - renal failure, CNS disease, infection

Late - MI

MSK LCRS (8 decks)

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