SLE Case and booklet Flashcards
What is lupus?
- AI disease
- Inadequate T cell suppressor activtity with increased B cell activity
- Most patients have antibodies to certain cell nucleus components
- Multisystem disease
Is SLE constant?
No - remission and flares
Can be familial
Common symptoms and signs of SLE
- Serositis - pleurisy and pericarditis
- Oral ulcers - painless, palate most specific
- Arthiritis - small joints, nonerosive
- Photosensitivity - or malar or discoid rash
- Blood disorders - low WCC, lymphopenia, thrombocytopenia, haemolytic anaemia
- Renal involvement - GN
- Autoantibodies (ANA +ve in more than 90%)
- Immunoligic tests - low complements
- Neurologic disorder - seizures or psychosis
SOAP BRAIN
Investigations for SLE
- Raised ESR or plasma viscosity
- FBC - Anaemia and leukopenia
- AI bloods
- Urinalysis - renal disease
- Skin biopsy
- Renal biopsy
What do antiphospholipid antibodies increase risk of?
- Pregnancy loss
- Thrombosis
What happens to C3 and C4 in SLE?
- Fall with disease severity
Autoimmune bloods for SLE
- Anti-nuclear antibody +ve
- Anti-Ro, Anti-La
- Anti ds-DNA rise with disease severity
- Antiphospholipid antibodies
Treatment for SLE
- Sun protection
- Advice on healthy lifestyle in view of CVS risk
- Hydroxychloroquine for rash and arthralgia
- Mycophenolate mofetil, azathioprine and rituximab are used too
What is used in SLE flares?
Prednisolone
Peak age onset SLE
Early adulthood
Oestrogen and autoimmune
- Estradiol may prolong the life of autoreactive B and T lymphocytes
UV and SLE
- UV light triggers SLE
- Alters DNA structure in the dermis which renders it more immunogenic
Drugs that trigger SLE like syndrome
- Isoniazid
- Minocycline
- TNF inhibitors
CRP in SLE?
Normal - but ESR and plasma viscosity
High risk with SLE
High CVD risk
Presentation of SLE
- Female, young
- Painful hand joints no swelling
- Raynauds
- Bald patches
- Pleuritic chest pain/resp manifestations
Examination findings for SLE
- Malar rash
- Pericardial rub?
- Mouth/nasal ulcers
- Discoid rash
- Alopecia
- Raynauds
- Leg oedema - problems with kidney
Diagnostic criteria for SLE
- SLE international collaborating clinics group (SLICC)
- Must have four of criteria including one clinical and immunological feature
- OR lupus nephritis + anti nuclear/antidsDNA
Clinical and immunological criteria for SLE
Clinical:
* Malar rash
* Cutaneous lupus - discoid
* Oral ulcers
* Non-scarring alpoecia
* Synovitis
* Serositis
* Renal - more than 500mg proteinuria in 24hrs
* Neuro - seizures etc
* Haemolytic anaemia of unknown cause
* Leukopenia/lymphopaenia
* thrombocytopenia
Immunological:
* ANA
* Anti-dsDNA
* Anti smooth muscle
* Low complement
* Antiphospholipid
* +ve direct Coombs test
What features suggest active disease/flare up?
- Painful swollen joints
- Increased fatigue
- Rashes
- Mouth/nasal ulcers
Treatment options SLE
Mild:
* Hydroxychloroquine
* Methotrexate
* Prednisolone
* NSAIDs
Moderate:
* Increased prednisolone
* Azathioprine
* Mycophenolate mofetil
* Cyclosporine
Severe:
* IV MPF
* Predisolone
* Cyclophosphamide
* Biologics? eg Rituximab
Monitoring requirements with SLE treatment
- FBC
- U&E
- LFTs
- BP
- Urinalysis
- Eye testing
- Blood glucose
