Systemic Lupus Erthematous Flashcards
Is SLE more prevalent in males or females?
Females 9:1 Males
Which ethnicities is SLE more common in? (2)
Afro-carribeans & Asians
What genes are involved in SLE? (3)
HLA B8, DR2 & DR3
10% of relatives may be affected
What infection can trigger SLE?
Epstein-Barr Virus (EBV)
What is the course of SLE?
Remitting and relapsing
What criteria are used to diagnose SLE? (11)
> =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
What does a malar rash look like?
Fixed eythema, over the cheek bones, sparing nasolabial folds
Butterfly rash
What does a discoid rash look like and where does it affect?
Erythematous raised patches
Adherent keratotic scales
`Follicular plugging
± Atrophic scarring
Ears, cheeks, scalp, forehead and chest
What are the characteristics of the arthritis involved in SLE?
> = 2 peripheral joints
Presents similar to RA
What rare arthropathy can occur in SLE?
Jaccoud’s arthropathy:
- Reversible deformity
- due to capsular laxity
What is serositis?
Inflammation of tissues lining lungs/heart
Pleuritis/pericarditis
How does pleuritis present?
Plueritic pain/dyspnoea
Due to pleaural effusion
How does pericarditis present?
Chest pain,
Pericardial rub
ECG
Signs of pericardial eddusion
What renal disorders occur in SLE? (2)
- Persistent proteinuria: >0.5g/d or 3+ urinalysis
- Cellular casts: red cell/granular/mixed
What neurological disorder can occur in SLE? (2)
Seizures and Psychosis
- in the absence of causative drugs or metabolic derangements
What blood disorders can occur in SLE? (4)
Haemolytic anaemia
Leukopenia
Lymphopenia
Thrombocytopenia
What immunological disorders can occur in SLE? Which antibodies may be present? (3)
- Anti-dnDNA
- Anti Sm
- Antiphospholipid anatibody
ANA antibody is positive in what % of patients with SLE?
> 95%
What tests do you sue to monitor SLE? (3)
- Anti-dsDNA antibody
- Complement (reduced C3 and C4)
- ESR
If ESR and CRP are high, what should you suspect (in the presence of multisystem disorder)?
Infection, serositis or arthritis
If ESR is high but CRP is low, what should you suspect (in presence of multisystem disorder)?
SLE
What drugs can induce lupus? (6)
Isoniazid (TB) Hydralazine (vasodilator) Procainamide (antiarrhythmic) Quinidine (antiarrhythmic) Chlorpromazine (antipsychotic) Phenytoin (epilepsy)
What drugs can worsen idiopathic SLE? (2)
Sulfonamides (Antibiotic)
Oral contraceptive pill
What would suggest a severe acute flare of SLE? (4)
- Haemolytic anaemia,
- nephritis,
- severe pericarditis
- or CNS
How would you manage a severe acute flare of SLE?
Urgent:
IV cyclophosphamide
High dose prednisolone
How would you manage cutaneous symptoms (rashes) of SLE?
Tx with topical steroids
Prevent with high factor sun block (sun exposure can trigger acute systemic flares too)
What maintenance therapy would you use for SLE?
- NSAIDs and hydroxychloroquine (DMARD) for joint/skin symptoms
- Low dose steroids for chronic disease
- Other DMARDs (Aza, methotrex)
What is the prognosis of SLE?
80% survival at 15 years
Increased long term risk of CVD and osteoporosis
What is the association between SLE and antiphospholipid syndrome?
20-30%
What occurs in antiphospolipid syndrome? (4)
CLOTs: Coagulation deficiency Livedo reticularis (mottled skin) Obstetric (recurrent miscarriages) Thrombocytopenia (low platelets)
Where do clots most commonly occur in antiphospholipid syndrome?
Cerebral and renal vessels
