Systemic Lupus Erythematosis

Question 1

What is SLE?

Answer 1

Chronic autoimmune disease involving the skin, joints, kidneys, blood cells and nervous system. It can affect almost every organ in the body.

Question 2

What is the cause of SLE?

Answer 2

Defect in apoptosis causes increased cell death and disturbance in immune tolerance leading to the development of autoantibodies. Immune complexes then form in small blood vessels leading to complement activation and inflammation. These immune complexes are deposited on the basement membranes of the skin an kidneys.

Question 3

Typical patient with SLE?

Answer 3

African American, Caribbean heritage, genetic predisposition, women of childbearing age

Question 4

How does SLE present?

Answer 4

Fever, fatigue, weight loss
Arthralgia, myalgia, inflammatory arthritis
Arthropathy is rarely erosive or deforming
Increased prevalence of avascular necrosis
Malar (butterfly) rash, photosensitivity, discoid lupus, subacute cutaneous lupus, oral/nasal ulceration
Alopecia
Lupus nephritis
Lung involvement
Blood cell involvement

Question 5

Tests for SLE

Answer 5

NO DIAGNOSTIC TEST
ANA - positive in 95% but non-specific
Anti-dsDNA - specific but varies with disease activity
Anti-Sm - specific but low sensitivity
Anti-Ro, anti-La, anti-RNP may be seen but also in other conditions
C3/C4 levels are low when disease is active esp. in renal disease
FBC for anaemia, leucopenia and thombocytopenia
Urinalysis –> glomerulonephritis
CT chest –> ILD
MRI brain –> cerebral vasculitis
Echo –> pericardial effusion

Question 6

Management of SLE with skin disease and arthralgia

Answer 6

Hydroxychloroquine, topical steroids and NSAIDs

Question 7

Management of SLE with inflammatory arthritis/ other organ involvement

Answer 7

Immunosuppression