SLE

Question 1

How many ACR criteria are required for a positive diagnosis of SLE?

Answer 1

Four or more

Question 2

What is a malar rash?

Answer 2

Fixed erythema, flat or raised, over the malar eminence (face/cheeks) tending to spare nasolabial folds

Question 3

What is a discoid rash?

Answer 3

Erythematous raised patches with adherent keratotic scaling and follicular plugging

Question 4

What is photosensitivity?

Answer 4

Skin rash due to reaction to sunlight

Question 5

What is serositis?

Answer 5

a) pleuritis (via a convincing history of pain and/or rub heard by physician and/or evidence of pleural effusion)

or

b) pericarditis (via EKG and/or rub heard and/or evidence of pericardial effusion)

Question 6

What complement findings are consistent with SLE?

Answer 6

Low C3 and/or low C4

Question 7

What factors determine time to clinical manifestation in SLE?

Answer 7

It is caused by environmental triggers in genetically susceptible people

Question 8

What is ANA?

Answer 8

An antibody that is important for a diagnosis of SLE. A negative test rules out SLE, a positive test does NOT confirm SLE.

Question 9

How are dsDNA antibodies used in the diagnosis of lupus?

Answer 9

If you have them, you have a confirmed lupus diagnosis given appropriate clinical story. If you don’t have them, you still could have SLE. They are also used to predict and track disease flares, and nephritis progression.

Question 10

What are anti-Smith antibodies?

Answer 10

They are used for diagnosis of SLE, but cannot track disease.

Question 11

What are anti-RNP antibodies associated with in diagnosis of SLE?

Answer 11

Raynaud’s and musculoskeletal complications

Question 12

What are anti-SSA/Ro and anti-SSB/La antibodies associated with in SLE?

Answer 12

They do not track disease, but can be suggestive of risk of the following:

• dry eyes/mouth
• subacute cutaneous lesions
• risk of having a child with neonatal lupus
• photosensitivity risk

Question 13

What do antiphospholipid antibodies suggest in SLE?

Answer 13

They are associated wtih clotting diathesis

Question 14

What is the presentation of SLE nephritis?

Answer 14

Mesangial cell/matrix inflammation, cellular proliferation, basement membrane abnormalities, and immune-complex deposition

Question 15

What antibodies are in subendothelial deposits in SLE nephritis?

Answer 15

IgM, IgG, and IgA as well as complement components

Question 16

What therapies are used for lupus?

Answer 16

Hydroxychloroquine, corticosteroids, cyclophosphamide, methotrexate, mycophenolate mofetil, azathioprine, and belimumab (a biologic)

All provide immunosuppression to limit autoimmunity without ablating the immune system