SLE - systemic lupus erythematosus .

Question 1

what is SLE

Answer 1

systemic autoimmune condition that effects the skin,joints, kidneys and nervous system

Question 2

aetiology of SLE

Answer 2

autoimmune

genetic predisposition HLA genes
increased oestrogen
some medications

Question 3

risk factors for SLE

Answer 3

women in childbearing years

afro-carribbean, asian, hispanic ethnicity

Question 4

SLE is autoimmune. What sort of hypersensitivity is this

Answer 4

type 3

Question 5

pathophysiology of SLE

Answer 5

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

Question 6

what are the non specific symptoms of SLE

Answer 6

fever
fatigue
weight loss

Question 7

cutaneous features of SLE

Answer 7

photosensitive rash - esp on face (malar rash)

non scarring alopecia

oral/ nasal ulcers

raynauds

Question 8

cutaneous features specific to subacute SLE

Answer 8

small erythramatous lesions on neck shoulders and forearms

Question 9

what % of SLE is subacute

Answer 9

10%

Question 10

cutaneous features specific to discoid lupus erythematosus

Answer 10

erythmatous raised scaling plaques with active inflammation - photosensitive

affects face, neck and head

associated with increased risk of developing SLE

Question 11

MSK symptoms of SLE

Answer 11

arthritis - synovitis or tenderness in 2 or more joints with >30mins ealry morning stiffness

arthralgia

myalgia

jaccouds arthropathy

Question 12

what is jaccouds arthropathhy

Answer 12

non erosive reversible joint disorder that can occur after repeated bouts of arthritis

occurs in 10-35% SLE pts

Question 13

signs of systemic SLE involvement

Answer 13

renal - lupus nephritis

neuro - seizure, psychiatric changes, headache

serositis - pleural or pericardial effusion,acute pericarditis

haem - leukopenia, thrombocytopenia, haemolytic anaemia, lymphadenopathy

Question 14

Ix used for suspected SLE

Answer 14

bloods - autoantibodies, FBC, compliment

urine dip

imaging - may be used to look for organ involvement

Question 15

what autoantibodies can be indicative of SLE

Answer 15

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

Question 16

blood results in lupus

Answer 16

autoantibodies present (ANA)
leukopenia
thrombocytopenia
haemolytic anaemia
low compliment levels

Question 17

urine dip reults in SLE

Answer 17

proteinuria

Question 18

general Mx of SLE

Answer 18

sun protection
minimize steroid use
monitor

Question 19

pharmacological management of mild-moderate SLE

Answer 19

hydroxychloroquine

short course of NSAIDs - symptomatic control

steroids- IA for arthritis, topical for cutaneous intervention

Question 20

when is SLE labelled as mild- moderate

Answer 20

skin disease and arthralgia

Question 21

when is SLE labelled as moderate - severe

Answer 21

inflammatory arthritis or organ involvement

Question 22

pharmacological Mx of moderate - severe SLE

Answer 22

hydroxychloroquine

acute flare- immunosuppressants/ oral steriods to induce remission

treat organ complications appropriately

Question 23

monitoring for SLE

Answer 23

anti-dsDNA antibodies and compliment levels to be checked regularly

urinalysis regularly for blood and protein

BP and cholesterol monitored - increased CVD risk

Question 24

complications of SLE

Answer 24

increased prevolance of avascular necrosis usually of the femoral head

may relate to steroid use