SLE

Question 1

What is SLE?

Answer 1

Systemic Lupus Erthymatosus is a chronic auto-immune condition in which the immune system attacks healthy tissues throughout the body.

Question 2

What is the pathophysiology?

Answer 2

A Type 3 hypersensitivity reaction associated with HLA B8, DR2, DR3. Immune system dysregulation leads to immune complex formation followed by deposition around the body that can affect any organ including the skin, joints, kidneys and brain.

Question 3

What are the risk factors?

Answer 3

• Race = Black & Asian
• Gender = Women (9:1)
• Genetics / FHx
• Smoking
• Medication
  
  • Isoniazid
  • Minocycline
  • TNF-inhibitors
• Exposure to sunlight
• Viral infections

Question 4

What are the symptoms/signs?

Answer 4

SOAP BRAIN (Common)

• Serositis
• Oral Ulcers
• Arthritis
• Photosensitivity
• Blood disorders
• Renal involvement
• Autoantibodies
• Immunologic tests
• Neurological disorder

Also: Alopecia

Question 5

What approach should you take when you suspect SLE (or any other rheumatological condition)?

Answer 5

Glove & Sweater Approach

• Start by asking about consitutional symptoms*
• (e.g. fever, fatigue, weight loss, night sweats, poor appetite)*

Glove

• Raynaud’s
• Joint pains & swelling
• Hand rash

Sweater

• Prox. muscle weakness & pain
• Hair loss
• Dry eyes / mouth
• Nose bleeds
• Mouth ulcers
• Pleuritic chest pain
• Pericardial pain
• Truncal rash/photosensitivity

Question 6

What is Raynaud’s?

Answer 6

Colour changes in the fingers from blue to WHITE/YELLOW to red.

In patients with darker skin tones this may be harder to recognise.

Associated symptoms :

• Tingling in the fingers
• Association with cold, stress
• Swelling
• Pain
• Sores (in severe cases)
• Gangrene/Infection (RARE)

Question 7

What is seen here?

Answer 7

Malar Rash

• Characteristic of SLE

Question 8

What type of rash is this?

Answer 8

Discoid rash

• Scaly, erythematous, well demarcated rash in sun-exposed areas.
• Lesions may progress to become pigmented and hyperkeratotic before becoming atrophic

Question 9

What indicates a significant amount of hair loss?

Answer 9

• Waking up with clumps of hair on the pillow.
• Visible thinning/bald patches.

Question 10

What “routine investigations” aide a diagnosis of SLE?

Answer 10

• FBC
• U&Es
  
  • ​​Decreased renal function
• LFTs
• Plasma Viscosity /ESR

CRP typically NORMAL in SLE

Question 11

What are abnormal FBC results are commonly seen in SLE?

Answer 11

• Anaemia (Haemolytic)
• Leukopenia (Low WCC)
• Lymphopenia
• Thrombocytopenia

Question 12

How is plasma viscosity / ESR affected?

Answer 12

Elevated

Question 13

What additional tests are important in diagnosing SLE?

Answer 13

• Autoantibodies
  
  • ANA
  • Anti-DsDNA antibodies
  • Anti Ro & La antibodies
  • Complements
  • Antiphospholipid antibodies
• Urinanalysis / dipstick
• Skin biopsy
• Renal biopsy

Question 14

What results would you expect from your specific tests?

Answer 14

• Anti Ro & La +ve
• Anti-dsDNA
  
  • Rises with disease activity
• C3 & C4 falls with flare ups

Question 15

Why is urine dipstick important?

Answer 15

To assess renal involvement

Question 16

What mneumonic is a useful diagnostic tool for SLE?

Answer 16

A RASH POINTS Medical Diagnosis

• ANA Positive
• Renal abnormalities
• Arthralgia/arthritis
• Serositis
• Haematological abnormalities
• Photosensitivity
• Oral Ulcers
• Immunological abnormalities
• Neurologic abnormalities
• Malar rash / Discoid rash

4 out of 11 items present = Definite Lupus

Question 17

What is the non-pharmaceutical management?

Answer 17

Lifestyle advice

• Sun protection
• Advice on healthy lifestyle

Question 18

What is the pharmaceutical management?

Answer 18

For rash & arthralgia:

• Hydroxychloroquin (1st line)

Can also consider:

• Mycophenolate mofetil
• Azathioprine
• Rituximab

For flare ups:

Prednisolone (Short course)