SLE Flashcards
Which six diseases contribute to the spectrum of autoimmune connective diseases?
Rheumatoid arthritis SLE Dermatomyositis Polymyositis System sclerosis Sjogren's syndrome
What is Sjogren’s syndrome?
Autoimmune attack against moisture production aka dry mouth and dry eyes
Describe the typical presentation of SLE
Malaise Fatigue Fever Weight Loss Lymphadenopathy
What are the specific features of SLE presentation?
Butterfly rash (malar rash)
Alopecia
Arthralgia
Raynaud’s phenomenon
What other organs may be affected in SLE?
Kidney
CNS
Heart
Lungs
Describe the cardiovascular complications of SLE
Accelerated atherosclerosis
Vasculitis
MI
How many of the 11 criteria does someone have to meet to have SLE?
4 out of 11
What are the criteria for an SLE diagnosis?
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
What renal disorders may be associated with SLE?
Proteinuria
What neurological disorders may be associated with SLE?
Seizures
Psychosis
What are the two types of rash associated with SLE?
Discoid rash
Malar rash
What is serositis?
Inflammation of a serous membrane
Give two examples of serositis associated with SLE
Pleuritis
Pericarditis
Briefly describe the process of autoantibody production in SLE
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
Which cell and antibody is mainly implicit in SLE?
B cells, IgG
What is the effect of autoantibody production?
Complement activation
Cytokine generation
End organ damage
Describe 3 common laboratory tests done for SLE
ANA
Anti-dsDNA and Anti-Sm
Anti-Rho and/or anti-La
What are the four patterns seen in positive ANA?
Homogenous
Speckled
Nucleolar
Centromere
Which ANA pattern correlates to antibodies against DNA?
Homogenous ANA
Which does a speckled ANA pattern show?
Antibodies against: Ro La Sm RNP
What does a nucleolar ANA pattern show?
Antibodies against topoisomerase
What does a nucleolar ANA pattern correlate with clinically?
Scleroderma
What does a centromere ANA pattern correlate with?
Some cutaneous scleroderma involvement
Compare the specificities of ANA and anti-dsDNA
ANA - non specific
Anti-dsDNA - more specific, less sensitive
What is specificity?
Ability for a test to correctly pick up when someone doesn’t have the disease (true negative)
What is sensitivity?
Ability for a test to correctly pick up a disease (true positive)
What other markers are picked up in lab tests for SLE?
Increased complement consumption
Anti-cardiolipin antibodies
Lupus anticoagulant
Beta-1 glycoprotein
What haematological features are seen in SLE?
Lymphopenia Normochromic anaemia Leukopenia AIHA Thrombocytopenia
What renal markers are seen in SLE?
Proteinuria
Haematuria
Active urinary sediment
How do you assess the severity of SLE?
Identify the pattern of organ involvement
Monitor function of these affected organs e.g. lung function tests, echocardiography
Identify pattern of autoantibodies expressed
Watching out for which clinical features will help to pre-empt severe attacks?
Weight loss Fatigue Malaise Hair loss Rash
Watching out for which laboratory features will help to pre-empt severe attacks?
ESR
Increased complement consumption
Increased anti-dsDNA
Which lab markers are poor indicators of an SLE attack?
ANA
CRP
How do you classify the severity of SLE?
Mild - join/skin involvement
Moderate - inflammation of organs
Severe - severe inflammation in vital organs incl lungs, kidney, CNS and heart
What is the first line of treatment for MILD SLE?
Paracetamol/NSAIDs
Hydroxychloroquine
Topical corticosteroids
What must you do whilst prescribing paracetamol or NSAIDs?
Monitor renal function
When would you give hydroxychloroquine in mild SLE?
If there’s any arthropathy or cutaneous manifestations
What is the indication for prescribing corticosteroids in moderate disease?
If NSAIDs and hydroxychloroquine didn’t work
Organ involvement/life threatening disease
Which drugs would you give for severe SLE?
Azathioprine
Cyclophosphamide
Mycophenolate mofetil
RItuximab
What is the bimodal mortality pattern of SLE?
Early active lupus - renal failure, CNS disease, infection
Late - MI
