SLE (Systemic lupus erythmatous) Flashcards
What is SLE?
hypersensitivity Type 3 reaction (Antigen Antibody complex)
Autoimmune systemic inflammation (any tissue/organ can be targeted)
Who is affected by SLE?
Females, afrocarribean, 20-40 pre menopause
Risk factors for SLE?
Female (12x more likely than M) - oestrogen?
HLA DR4/DR3/B8
Drugs (eg. isoniazid, procainomide)
UV light
What causes SLE to occur?
Genes or environment
Genes + environment
Pathology of SLE
Apoptosis (cell death) = produces apoptotic bodies + exposes inside of cell (nucleus) - called NUCLEAR ANTIGENS - genes make them more susceptible to attack
B cells activate and produce Ab against (Anti Nuclear Ab - ANA)
Antigen-Ab complexes go into blood and deposit or stick to vessel walls in kidneys, skin, joints, heart, brain
Cause local inflammation in that area + cause tissue damage
Easy pathology of SLE
Impaired apoptotic debris, presented to TH2, B cell activation, Antigen Ab complexes
Typical Symptoms of someone with SLE
Fever, Rash, Joint pain
(Immune system attacking organs)
What other Sx will someone with SLE have? (affecting organ systems)
*Butterfly rash + Photosensitivity (on cheeks, exposed to sun = rash) - SKIN
*Glomerulonephritis (nephritic syndrome) - KIDNEYS
Seizures + psychosis - BRAIN
Mouth Ulcers - MUCOSA
Serositis (inflam of serosa = Pleural/peritoneal/pericardial inflammation) - SEROSA
Anemia - BLOOD
*Joint Pain, deforming arthritis - JOINTS
*Raynaud’s, Pyrexia
Pulmonary Embolism (associated with anti phospholipid syndrome)
How to diagnose SLE?
Bloods = Anemia, High ESR, NORMAL CRP
Urine dipstick = +ve Haematuria (blood) and proteinuria (nephritic syndrome)
Low C3/C4
Serology = ANA Abs (anti nuclear Abs) - 99% cases
Anti dsDNA Abs (used to monitor progress)
(+ Anti RO, SM, La)
What 2/3 antibodies would you test for to get a diagnosis?
ANA - VERY SENSITIVE
Anti dsDNA or Anti Smith - very specific
Treatment for SLE
Lifestyle (less sunlight + stop triggering drugs) - prevent
Corticosteroids (main) eg. prednisolone - limit severity
+ Hydroxychloroquine (DMARD)
+ NSAIDs
What else is given if severe?
Azathioprine
What else is hydroxychloroquine used as?
Anti malarial
What is the aim one SLE is stable?
Taper off other drugs so only on hydroxychloroquine
