Systemic Lupus Erythematosus

Question 1

What is the underlying pathophysiology for SLE?

Answer 1

Anti-nuclear antibodies form which target proteins in hosts cell nuclei leading to systemic immune activation and consequent inflammatory response

Question 2

SLE is associated with non-specific systemic symptoms. What are they and how would you expect someone to present?

Answer 2

Fatigue 
Weight loss 
Arthralgia 
Myalgia 
Fever 
Photosensitive malar rash
-butterfly shaped rash across nose and cheeks which is exacerbated by sunlight 
SOB
Pleuritic chest pain 
Splenomegaly
Lymphadenopathy 
Mouth ulcers 
Hair loss

Question 3

What 2 antibodies can you test for in someone suspected of SLE?

Answer 3

Anti-nuclear antibodies (ANA)= initial step
-can be positive in healthy patients and people with other AI conditions so needs to be considered in context of symptoms

Anti-double stranded DNA (anti-dsDNA)

• specific to SLE
• can be used to monitor the level of disease activity and response to treatment

Question 4

What are the common complications of SLE?

Answer 4

CVS disease due to chronic inflammation of BV leading to HTN and CAD

Infection due to disease and immunosuppressants

Anaemia of chronic disease
-SLE affects bone marrow causing normocytic anaemia

Pericarditis

Pleuritis

Interstitial lung disease

Question 5

What are the 1st line treatments for SLE? What is the main aim of these treatments?

Answer 5

NSAIDs
Steroids (prednisolone)
Hydroxychloroquine
Suncream and sun avoidance

Reduce symptoms and complications

Question 6

SLE can give rise to lupus arthritis. How would you describe the characteristics of this form of arthritis? How can you differentiate from RA?

Answer 6

Inflammatory symmetrical polyarthritis affecting small joints (MCP and PIP)

LA associated with malar flush and mouth ulcers
RA has characteristics finger deformities