SLE Flashcards
What is SLE?
Inflammatory autoimmune connective tissue disease, affecting multiple organs and systems
Describe the pathophysiology of SLE.
- Anti-nuclear antibodies (to proteins in cell nuclei)
- Immune system attacks proteins in cell nuclei
How does SLE present?
- Photosensitive malar rash (butterfly rash across nose and cheeks that’s worse with sunlight)
- Constitutional - weight loss, fatigue, fever
- Arthralgia and myalgia
- Dyspnoea, pleuritic chest pain
- Raynaud’s phenomenon
- Lymphadenopathy and splenomegaly
What bloods should you do?
Autoantibodies- ANA (anti-nuclear ABs), anti-dsDNA
Inflammation- C3, C4, CRP, ESR, Immunoglobulins (B cell activation)
FBC- normocytic anaemia of chronic disease
What special testing is useful?
Renal biopsy, urinalysis and urine protein:creatinine ratio (lupus nephritis)
What criteria can be used in diagnosing SLE?
- SLICC criteria
- ACR criteria
What are the main complications of SLE?
Cardiovascular- vasculitis leads to HTN and coronary artery disease. Pericarditis also occurs
Infection- both due to SLE and secondary to immunosuppressants
Anaemia of chronic disease- normocytic anaemia
Resp- pleuritis and secondary pulmonary fibrosis
Renal/Repro- lupus nephritis, recurrent miscarriage
What is the first line treatment in SLE?
- NSAIDs and steroids e.g. prednisolone
- Hydroxychloroquine (First line if mild)
- Suncream and sun avoidance
Which immunosuppressants are commonly used in moderate-severe SLE?
- Methotrexate- anti-folate
- Azathioprine- purine synthesis inhibitor (less DNA/RNA produced)
- Tacrolimus- inhibits calcineurin phosphatase (Ca2+ dependent events e.g. apoptosis)
- Ciclosporin- inhibits IL-2 transcription, so less T cells activated
What biological therapies are used?
- Rituximab- MAB against CD20 on B cell surfaces
- Belimumab- MAB against B-cell activating factor
