SLE and antiphospholipid syndrome

Question 1

Name the organs affected by SLE (5)

Answer 1

Brain, heart, lungs, kidney and skin

Question 2

What is the mnemonic for symptoms and signs in SLE ?

Answer 2

A RASH POINts MD

Question 3

What are the symptoms and signs in SLE ? 😭

Answer 3

A RASH POINts MDD
Arthritis (symmetrical poly arthritis) + myalgia

Renal problems (glomerulonephritis)
Raynauds 
ANA (serum) +ve in 90%
Serositis (pleurisy, pericarditis) + PG
Haematological
- low hb (normocyctic hypochromic anaemia)
- low platelets (thrombocytopenia)
-low WCC (leukopenia)

Photo-sensitivity 
Oral ulcers 
Immunology:
-anti-dsDNA, anti Smith, ENA +ve: Ro/la, RNP
\+ antiohospholipid (anticardiolapin)
Neurological (seizures)

Malar rash (butterfly: symmetrical erythematous rash on cheeks and bridge of nose
Discoid rash: scaly erythematous plaques on face
Dry eyes and mouth

Question 4

What is the mnemonic for taking a history in a patient with suspected SLE ? 😭

Answer 4

No RMDS
Neurological symptoms: (4)
- headache 
- visual disturbance 
- sensory loss: numbness 
- weakness 
Rash, Mouth ulcers, dry eyes and mouth; Serositis (SOB, chest pain)

Question 5

List the investigations for SLE with regards to the Ff: 😭

• bloods (4)
• special bloods/test (3)
• others (5)

Answer 5

-Bloods: FBC, U and E, ESR and CRP
-Special Bloods/Test: ANA +ve, RF +ve and low C3 and C4
Others: anti-dsDNA, anti-Sm, anti- Ro/la, RGP, anti-cardiolipin

Question 6

Describe the management of SLE (2)

Answer 6

• Mild/maintenance: NSAIDs + PPI + oral DMARD e.g. hydroxycholoroquine
• severe/acute: High dose prednisolone + DMARDs

Question 7

What are the 2 different types of Antiphospholipid syndrome?

Answer 7

Primary: Autoantibodies attacking phospholipids

Secondary occurring as a result of SLE

Question 8

What is the mnemonic for the signs and symptoms of Antiphospholipid syndrome ? 😭

Answer 8

CLOTs
Clots: Venous e.g DVT and Arterial e.g Stroke
Livido Revticularis: classical LACE like rash
Obstetrics complications: Recurrent 2/3rd Trimester miscarriages

Question 9

What investigations would you do for Antiphospholipid syndrome, with regards ?

• Blood (1)
• special Blood (2)

Answer 9

• Bloods: Clotting (increase in APTT)

- special bloods: ANA -ve and anticardiolapin

Question 10

What is the management of Antiphospholipid syndrome ? (2)

Answer 10

If Hx of severe thrombosis: Warfarin

If not Hx of thrombosis: low dose Aspirin