SLE - systemic lupus erythematosus . Flashcards
what is SLE
systemic autoimmune condition that effects the skin,joints, kidneys and nervous system
aetiology of SLE
autoimmune
genetic predisposition HLA genes
increased oestrogen
some medications
risk factors for SLE
women in childbearing years
afro-carribbean, asian, hispanic ethnicity
SLE is autoimmune. What sort of hypersensitivity is this
type 3
pathophysiology of SLE
loss of immune regulation - increased/ defective apoptosis
necrotic cells release nuclear materials - act as autoantigens
autoimmunity occurs - type 3 hypersensitivity
activation of the compliment pathway - attracts leukocytes which release cytokines
cytokine release causes inflammation - necrosis and scarring
what are the non specific symptoms of SLE
fever
fatigue
weight loss
cutaneous features of SLE
photosensitive rash - esp on face (malar rash)
non scarring alopecia
oral/ nasal ulcers
raynauds
cutaneous features specific to subacute SLE
small erythramatous lesions on neck shoulders and forearms
what % of SLE is subacute
10%
cutaneous features specific to discoid lupus erythematosus
erythmatous raised scaling plaques with active inflammation - photosensitive
affects face, neck and head
associated with increased risk of developing SLE
MSK symptoms of SLE
arthritis - synovitis or tenderness in 2 or more joints with >30mins ealry morning stiffness
arthralgia
myalgia
jaccouds arthropathy
what is jaccouds arthropathhy
non erosive reversible joint disorder that can occur after repeated bouts of arthritis
occurs in 10-35% SLE pts
signs of systemic SLE involvement
renal - lupus nephritis
neuro - seizure, psychiatric changes, headache
serositis - pleural or pericardial effusion,acute pericarditis
haem - leukopenia, thrombocytopenia, haemolytic anaemia, lymphadenopathy
Ix used for suspected SLE
bloods - autoantibodies, FBC, compliment
urine dip
imaging - may be used to look for organ involvement
what autoantibodies can be indicative of SLE
ANA - present in almost all SLE pts
anti-dsDNA - associated with lupus nephritis
APLS (antiphospholipid antibodies) - associated with thrombosis and recurrent miscarriage
anti-Ro
anti-Smith
blood results in lupus
autoantibodies present (ANA)
leukopenia
thrombocytopenia
haemolytic anaemia
low compliment levels
urine dip reults in SLE
proteinuria
general Mx of SLE
sun protection
minimize steroid use
monitor
pharmacological management of mild-moderate SLE
hydroxychloroquine
short course of NSAIDs - symptomatic control
steroids- IA for arthritis, topical for cutaneous intervention
when is SLE labelled as mild- moderate
skin disease and arthralgia
when is SLE labelled as moderate - severe
inflammatory arthritis or organ involvement
pharmacological Mx of moderate - severe SLE
hydroxychloroquine
acute flare- immunosuppressants/ oral steriods to induce remission
treat organ complications appropriately
monitoring for SLE
anti-dsDNA antibodies and compliment levels to be checked regularly
urinalysis regularly for blood and protein
BP and cholesterol monitored - increased CVD risk
complications of SLE
increased prevolance of avascular necrosis usually of the femoral head
may relate to steroid use
