Systemic Lupus Erythemateous (SLE) Flashcards
The cause is unknown!
What are autoantibodies made against?
What is formed as a result?
What drugs could trigger lupus?
ANA - AUTOANTIGENS
Immune complexes
Inadequate clearance of immune complexes results in a host of immune responses which cause tissue inflammation and damage.
Isoniazid
Hydralazine
What sex does it appear more in?
What race is it more common in?
Women
African Americans and Asians
Presentation:
It is a relapsing-remitting disease with varying severity!!
What systemic symptoms do they get?
MSK - They get arthritis:
- Is it sym/assym?
- When do they have stiffness?
- What else may be present along with the arthritis? - 3
Malaise
Fever
Weight loss
Lymphadenopathy
Symmterical arthritis
Morning stiffness
Myalgia
Tenosynovitis
Tendon rupture
Presentation:
Skin:
- Where does an ACUTE malar rash occur?
- What type of CHRONIC rash do they get?
What is lupus nephritis?
Serositis is inflammation of a serous membrane. Where does this occur and can therefore cause?
On the face - looks like a butterfly
Discord rash - lookup - occurs on
Lupus nephritis is an inflammation of the kidney that is caused by systemic lupus erythematosus (SLE).
Lungs - pleurisy
Heart - pericarditis
Both cause SOB and chest pain
Presentation:
Respiratory:
It can cause pleurisy, ILD, pulmonary haemorrhage. What S+S will they get with haemorrhage?
It can also cause a range of CVD complications.
What forms in the mouth and on the nose?
They also get alopecia and sicca. What is sicca?
SOB and haemoptysis
Ulcers - nasal and oral
Dryness of the exocrine glands, particularly the eyes and mouth, is referred to as “sicca syndrome” or “sicca complex” when there is no evidence of autoimmune disease present.
Sjögren’s syndrome is when there is an autoimmune cause for it.
Presentation:
What GI effects can you think of?
They also get a range of neurological complications!
D&V
Abdo pain
Splenomegaly
Dysphagia
Immunology - what antibody is linked to lupus?
A positive result on an ANA (AntiNuclear Antibodies) were found in your blood. You may get a positive result if: You have SLE (lupus). You have a different type of autoimmune disease.
Investigations:
Full bloods are done!
What is checked when they have myalgia and muscle weakness?
ANA is obviously screened for and there are a range of immune markers that can be looked for!
There is a diagnostic criteria where 4 out of 17 are required. Look at page 555 for more if you wish!
CK - creatine kinase
Management:
Same as always with immunosuppressive therapies!
General measures:
- Why do they need sunblock?
- What drug, used for malaria, is also given for joint and skin symptoms?
- What can be added to this?
They may also have life/organ threatening (e.g. haemolytic anaemia, severe pericarditis, CNS disease). What needs to be given?
They are more photosensitive
Hydroxychloroquine
Steroids if there is a flare-up especially
High dose steroids + seek help
Hydroxychloroquine:
It has a range of side effects.
How long does it take to work?
Why does an annual visual acuity check need to be done?
What will decrease effectiveness?
3 months - 9 months for full effect
Can cause retinopathy
Smoking
What other disease is associated with SLE?
Antiphospholipid Syndrome
Antiphospholipid Syndrome:
What is it knowing the name?
Presentation:
CLOT mneumonic:
- C - may lead to pulmonary HTN eventually?
- Livedo reticularis - what is it?
- O - what does it cause in obstetrics?
- Thrombocytopenia
There are antibodies made against the phospholipids of the cell membranes!
Clots - increases coag - both venous and arterial
Livedo reticularis refers to various conditions in which there is mottled discolouration of the skin. It is described as being reticular (net-like, lace-like), as cyanotic discolouration surrounds pale central skin.
Obstetric problems - Recurrent miscarriage
Antiphospholipid Syndrome:
Investigations - coag and antibodies are tested for!
Management:
- How is vascular risk managed?
- What med can be prescribed to reduce it?
Exercise
Smoking cessation
Weight loss
BP and lipid control
Aspirin
