SLE Flashcards
What is SLE?
Systemic lupus erythematosus (“lupus”) is an inflammatory autoimmune connective tissue disease.
Clinical features
relapsing-remitting course, with flares
Clinical Features
Fatigue
Weight loss
Arthralgia (joint pain) and non-erosive arthritis
Myalgia (muscle pain)
Fever
PHOTOSENSITIVE MALAR RASH. This is a “butterfly” shaped rash across the nose and cheek bones that gets worse with sunlight.
Lymphadenopathy and splenomegaly
Shortness of breath
Pleuritic chest pain
Mouth ulcers
Hair loss
Raynaud’s phenomenon
Diagnosis
Autoantibodies (see below)
Full blood count (normocytic anaemia of chronic disease)
C3 and C4 levels (decreased in active disease)
CRP and ESR (raised with active inflammation)
Autoantibodies
Urinalysis and urine protein:creatinine ratio for proteinuria in lupus nephritis
Renal biopsy can be used to investigate for lupus nephritis
Autoantibodies associated with SLE
First step: Anti-nuclear Antibodies
Specific: Anti-dsDNA (also less famously Anti-smith)
Complications
Cardiovascular disease
Pericarditis
Recurrent miscarriage
Lupus nephritis - full renal failure requires steroids and cyclophosphamide
Pulmonary fibrosis
Anaemia of chronic disease
Management
HYDROXYCHLOROQUINE is first line in mild SLE
NSAIDs
Steroids (prednisolone)
DMARDs:
- Azathioprine
- Methotrexate
- Tacrolimus
Biologics:
- Rituximab
- Belimumab (monoclonal antibody against B cell activating factor)
Discoid lupus erythematous
What is it?
non-cancerous chronic skin condition associated with an increased risk of developing SLE
Rarely the lesions can develop into squamous cell carcinoma
Discoid lupus erythematous
Clinical features
lesions occur on face, ears and scalp: photosensitive
(inflamed, dry, erythematous, patchy)
scarring alopecia (hair loss in affected areas that does not grow back)
hyper-pigmented or hypo-pigmented scars
Discoid lupus erythematous
Diagnosis
Biopsy
Discoid lupus erythematous
Management
Sun protection
Topical steroids
Intralesional steroid injections
Hydroxychloroquine
Drug induced lupus
Clinical features
Causes
lupus-like fever, arthralgia and rash syndrome
Causes: hydralazine, isoniazid, minocycline
Joint manifestation
Jaccoud’s arthropathy - rheumatoid like arthritis with hyper-extended PIP joints that are reducible in extension
