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Rheumatology > Systemic Lupus Erthematous > Flashcards

Systemic Lupus Erthematous Flashcards

1
Q

Is SLE more prevalent in males or females?

A

Females 9:1 Males

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2
Q

Which ethnicities is SLE more common in? (2)

A

Afro-carribeans & Asians

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3
Q

What genes are involved in SLE? (3)

A

HLA B8, DR2 & DR3

10% of relatives may be affected

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4
Q

What infection can trigger SLE?

A

Epstein-Barr Virus (EBV)

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5
Q

What is the course of SLE?

A

Remitting and relapsing

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6
Q

What criteria are used to diagnose SLE? (11)

A

> =4: SOAP BRAIN MD

  • Serositis
  • Oral ulcers
  • Arthritis
  • Photosensitivity (skin)
  • Blood disorder
  • Renal disorder
  • ANA +ve (>90%)
  • Immunological disorder
  • Neurological disorder
  • Malar rash
  • Discoid rash
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7
Q

What does a malar rash look like?

A

Fixed eythema, over the cheek bones, sparing nasolabial folds

Butterfly rash

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8
Q

What does a discoid rash look like and where does it affect?

A

Erythematous raised patches
Adherent keratotic scales
`Follicular plugging
± Atrophic scarring

Ears, cheeks, scalp, forehead and chest

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9
Q

What are the characteristics of the arthritis involved in SLE?

A

> = 2 peripheral joints

Presents similar to RA

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10
Q

What rare arthropathy can occur in SLE?

A

Jaccoud’s arthropathy:

  • Reversible deformity
  • due to capsular laxity
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11
Q

What is serositis?

A

Inflammation of tissues lining lungs/heart

Pleuritis/pericarditis

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12
Q

How does pleuritis present?

A

Plueritic pain/dyspnoea

Due to pleaural effusion

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13
Q

How does pericarditis present?

A

Chest pain,
Pericardial rub
ECG
Signs of pericardial eddusion

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14
Q

What renal disorders occur in SLE? (2)

A
  • Persistent proteinuria: >0.5g/d or 3+ urinalysis

- Cellular casts: red cell/granular/mixed

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15
Q

What neurological disorder can occur in SLE? (2)

A

Seizures and Psychosis

- in the absence of causative drugs or metabolic derangements

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16
Q

What blood disorders can occur in SLE? (4)

A

Haemolytic anaemia
Leukopenia
Lymphopenia
Thrombocytopenia

17
Q

What immunological disorders can occur in SLE? Which antibodies may be present? (3)

A
  • Anti-dnDNA
  • Anti Sm
  • Antiphospholipid anatibody
18
Q

ANA antibody is positive in what % of patients with SLE?

A

> 95%

19
Q

What tests do you sue to monitor SLE? (3)

A
  • Anti-dsDNA antibody
  • Complement (reduced C3 and C4)
  • ESR
20
Q

If ESR and CRP are high, what should you suspect (in the presence of multisystem disorder)?

A

Infection, serositis or arthritis

21
Q

If ESR is high but CRP is low, what should you suspect (in presence of multisystem disorder)?

A

SLE

22
Q

What drugs can induce lupus? (6)

A 
Isoniazid (TB)
Hydralazine (vasodilator)
Procainamide (antiarrhythmic)
Quinidine (antiarrhythmic)
Chlorpromazine (antipsychotic)
Phenytoin (epilepsy)
23
Q

What drugs can worsen idiopathic SLE? (2)

A

Sulfonamides (Antibiotic)

Oral contraceptive pill

24
Q

What would suggest a severe acute flare of SLE? (4)

A
  • Haemolytic anaemia,
  • nephritis,
  • severe pericarditis
  • or CNS
25
Q

How would you manage a severe acute flare of SLE?

A

Urgent:
IV cyclophosphamide
High dose prednisolone

26
Q

How would you manage cutaneous symptoms (rashes) of SLE?

A

Tx with topical steroids

Prevent with high factor sun block (sun exposure can trigger acute systemic flares too)

27
Q

What maintenance therapy would you use for SLE?

A
  • NSAIDs and hydroxychloroquine (DMARD) for joint/skin symptoms
  • Low dose steroids for chronic disease
  • Other DMARDs (Aza, methotrex)
28
Q

What is the prognosis of SLE?

A

80% survival at 15 years

Increased long term risk of CVD and osteoporosis

29
Q

What is the association between SLE and antiphospholipid syndrome?

A

20-30%

30
Q

What occurs in antiphospolipid syndrome? (4)

A 
CLOTs:
Coagulation deficiency
Livedo reticularis (mottled skin)
Obstetric (recurrent miscarriages)
Thrombocytopenia (low platelets)
31
Q

Where do clots most commonly occur in antiphospholipid syndrome?

A

Cerebral and renal vessels

Rheumatology (11 decks)

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