SLE Flashcards
Define SLE?
mutlisystem inflamatory autoimmune disorder in which anti-nuclear antibodies are made against a variety of autoantigens
what is the diagnostic criteria for SLE?
4/11: SOAP BRAIN MD+ reduced complement
Serositis – pleuritis or pericarditis
Oral ulcers
Arthritis (non-erosive)
Photosensitivity
Bloods (haemolytic anaemia/leukopaenia/thrombocytopaenia)
Renal disease (glomerulonephritis/ urine casts)/ Raynauds
ANA
Immunological disorder (anti-dsDNA/anti-Sm/anti-phospholipid)
Neurological disease (psychosis/seizures)
Malar rash
Discoid rash
summarise the epidemiology of SLE?
COMMON
1-2/1000
More common in the YOUNG
More common in AFRO-CARIBBEAN and CHINESE
9 x more common in FEMALES
Which autoimmune conditions is SLE associated with?
Sjogrens, autoimmune thyroid diseas, NHL, Antiphospholipid syndrome, etc
what environmental factors are associated with SLE?
UV rad
Estrogen
Infectious e.g. EBV
Drugs e.g. sulfasalazine, sulfonamides, methyldopa, oral contraceptives, phenylbutazone, etc
Describe the immunology of SLE?
>95% are ANA+ve
Anti-dsDNA is highly specific but only present in 60%
ENA may be positive in 20-30% - anti-Ro, anti-La, anti-Sm, anti-RNP
40% are RhF+
Whar may be the cause of tissue damage?
immune complex deposition
which HLAs are associated with SLE?
HLAB8, DR2 and DR3
what are the presenting symptoms of SLE?
RELAPSING AND REMITTING
SOAP BRAIN MD
General Symptoms
- Fever
- Fatigue
- Weight loss
- Lymphadenopathy
- Splenomegaly
Raynaud’s phenomenon – numbness of fingers/toes in cold
Oral ulcers
Skin Rash
- Malar rash
- Discoid lupus (red scaly patches)
Atypical rashes (e.g. photosensitivity, vasculitis, urticaria, purpura)
give 6 points for the systemic involvement of SLE?
Musculoskeletal – arthritis/athralgia, tendonitis, myopathy, fibromyalgia
Heart - pericarditis, myocarditis, arrhythmias, Libman-Sacks endocarditis, HT => chest pain and SOB
Lung - pleurisy, pleural effusion,pneumonitis, pulmonary HTN,basal atelectasis, restrictivelung defects
Neurological - headache, stroke, cranial nerve palsies, confusion, chorea
Psychiatric - depression, psychosis
Renal - glomerulonephritis
GI – abdo pain, V+ D
Other – lymphadenopathy, venous/ arterial thrombosis (due to presence of antiphospholipid antibodies), alopecia
outline the management of SLE?
Careful counselling
lifestyle- diet, exercise, mental wellbeing, flu jab, family wellbeing
symptomatic - pain control, NSAIDs , analgesia, physiotherapy
specialist- steroids, hydroxychloroquine, cyclophosphamide, mycophenolate, azathioprine, biologics
outline the prognosis of SLE?
improving more recently
renal involvement= poor indicator
what are the 3 classes of investigations for SLE?
bloods
autoanitbodies
systemic investigations
describe the bloods in SLE?
FBC – anaemia, leukopenia, thrombocytopenia but rarely all 3 at once
U&E – elevated urea and cr
LFT
Raised ESR + CRP– could prompt a search for infection
Clotting – may be prolonged if antiphospholipid antibodies
Complement – consumption of complement causes low C3 and C4 but high C3d and C4d (degradation products)
What are the important autoantibodies to investigate in SLE?
ANA -MOST SENSITIVE
Anti-dsDNA (60%) - highly spec
Rheumatoid factor (30-50%)
Anti-SM -MOST SPEC (but not present in many)
