SLE & Sjogren's Flashcards
What HLA is associated with SLE?
HLA B8, DR2 & DR3
In what population is SLE commonly seen in?
Women of child bearing age
Asians and Afro-Caribbeans
What are the clinical features of SLE?
‘MD SOAP BRAIN’
Malar rash
Discoid rash
Serositis (pericarditis/pleuritis)
Oral ulcers
Arthritis
Photosensitivity
Blood disturbance Renal ANA+ Immunological investigations Neurological (seizures)
What do immunological tests in SLE show?
> 95% are ANA+. ANA encompasses all of the following immunological markers:
Anti-dsDNA is the most specific and found in 60%
ENA is found in 40% (anti-Ro, anti-La, anti-Sm, anti-RNP)
40% are RF+
Antiphospholipid antibodies may be present (anticardiolipin or lupus anticoagulant)
What are the three best tests to diagnose SLE?
1) Anti-dsDNA antibody
2) C3 and C4 levels (will be decreased)
3) Raised ESR but CRP normal
What are the causes of drug induced lupus?
'SHIPP' Sulfonamide Hydralazine Isoniazid Phenytoin Procainamide
The disease remits if the drug is stopped.
Anti-histone antibodies are present in most people with drug induced lupus
What are the general management measures and maintenance management of someone with SLE?
Heavy sunblock
Hydroxychloroquine unless CI
Maintenance: NSAIDs and hydroxychloroquine
Azathioprine, methotrexate as steroid sparing agents
What do you use for mild, moderate and severe flares of SLE?
Mild: hydroxychloroquine
Moderate: mycophenolate or DMARDs
Severe: High dose steroids, mycophenolate, rituximab, cyclophosphamide
What can antiphospholipid antibodies cause?
Antiphospholipid antibodies are the anticardiolipin and lupus anticoagulant antibodies
Can cause CLOTs Coagulation defect Livedo reticularis Obstetric (recurrent miscarriage) Thrombocytopenia
What is the laboratory criteria to have a diagnosis of SLE?
Positive ANA Anti-dsDNA Anti-Smith antibodies Antiphospholipid antibodies present Low complement levels Positive direct Coombs test
What is scleroderma?
Tightening and fibrosis of the skin
May manifest as plaques
ANA + in 90%
What is myositis?
Autoimmune mediated striated muscle inflammation
Two types: polymyositis or dermatomyositis
Polymyositis: Insidious onset of progressive symmetrical muscle weakness. Dysphagia, dysphonia or respiratory weakness.
Dermatomyositis: Myositis + skin signs. Shawl sign positive (macular rash). Heliotrope rash on eyelids. ANA antibodies will be present.
What do tests show in myositis?
Muscle enzymes increased in plasma
EMG and biopsy confirm diagnosis
MRI shows muscle oedema
What is the management of myositis?
Start prednisolone
Use hydroxychloroquine for skin disease
What are the features of Sjogren’s syndrome?
Dry mucosal surfaces Keratoconjunctivitis sicca Vaginal dryness Arthralgia Raynaud's Parotitis
