SLE

Question 1

What is SLE?

Answer 1

multi-system inflammatory AI disorder

Question 2

What acronym characterises SLE?

Answer 2

Serositis
Oral ulcers
Arthritis (non-erosive)
Photosensitivity
Bloods (haemolytic anaemia/ leukopaenia/ thrombocytopaenia)
Renal disease (urine casts/ proteinuria)
ANA
Immunological disorder (anti-dsDNA/ anti-Sm/ anti-phospholipid)
Neurological disease (psychosis/ seizures)
Malar rash
Discoid rash

Question 3

The American College of Rheumatology provides high sensitivity and specificity for diagnosis of SLE, what is this composed of?

Answer 3

4/11 of diagnostic criteria SOAP BRAIN MD

Question 4

Describe the aetiology of SLE

Answer 4

UNKNOWN
Tissue damage may be caused by vascular immune complex deposition
Could be due to a combination of hormonal, genetic + exogenous factors

Question 5

Describe the epidemiology of SLE

Answer 5

COMMON 
1-2/1000 
More common in YOUNG  
More common in AFRO-CARIBBEAN + CHINESE 
F >> M

Question 6

List 7 general signs and symptoms of SLE

Answer 6

Fever  
Fatigue  
Weight loss  
Lymphadenopathy 
Splenomegaly 
Raynaud's phenomenon 
Oral ulcers

Question 7

What symptoms are caused by systemic involvement in SLE?

Answer 7

MSK: arthritis, tendonitis, myopathy
CVS: pericarditis, myocarditis, arrhythmias, Libman-Sacks endocarditis
Lung: pleurisy, pleural effusion, basal atelectasis, restrictive lung defects
CNS: headache, stroke, CN palsies, confusion, chorea
Psychiatric: depression, psychosis
Renal: glomerulonephritis

Question 8

What bloods are investigated in SLE?

Answer 8

FBC: Lymphocytopenia, anaemia 
Leukopaenia, Thrombocytopenia, AIHA
U+E: Renal manifestations
Raised ESR  
NORMAL CRP 
Autoantibodies

Question 9

What autoantibodies are screened for in SLE?

Answer 9

ANA
Anti-dsDNA
Anti-Sm
Rheumatoid factor
Anti-phospholipid antibodies

Question 10

What other investigations are performed in SLE?

Answer 10

Urine: haematuria, proteinuria, red cell casts
Joints: plain radiographs
Heart + Lungs: CXR, ECG, echocardiogram, CT
Kidneys: renal biopsy (if glomerulonephritis suspected)
CNS: MRI, LP

Question 11

List 3 dermatological features of SLE

Answer 11

Malar rash "butterfly"
Discoid lupus (red scaly patches) 
Atypical rashes (e.g. photosensitivity, vasculitis)

Question 12

List 5 environmental triggers of SLE

Answer 12

Cigarette smoking 
Silica exposure
UV light 
EBV infection
Isoniazid

Question 13

Which MHC is SLE associated with?

Answer 13

HLA DR3