Systemic Lupus Erythematosus Flashcards
what is SLE?
multi-system auto-immune disease manifesting differently in different patients
what is the epidemiology of SLE?
- female
- afro-caribbean
what is the classical presentation of SLE?
- systemic upset - fever/myalgia/fatigue/weight loss
- joint and/or skin involvement
what are the triggers for a flare-up of SLE?
- oestrogen-containing contraception
- overexposure to sunlight
- infections
- stress
what are the dermatological presentations of SLE?
- photosensitivity - malar rash
- discoid rash (round, raised plaques)
- mouth/nose/genital ulcers
- hair loss
- cutaneous vasculitis - splinter haemorrhages/purpura
what is a malar rash?
symmetrical, butterfly shaped rash across both cheeks
what is discoid lupus?
discoid rash alone with no other features of SLE
what is the typical joint manifestation in SLE?
- arthritis (non-erosive) or arthralgia
- polyarthritis
- symmetrical or asymmetrical
what is the cardiovascular presentation of SLE?
- raynauds phenomenon
- pericarditis
- myocarditis
- increased cardiovascular disease risk
what is the respiratory presentation of SLE?
- pleurisy and pleural effusions
- pneuomonitis - acute can mimic pneumonia and chronic causes pulmonary fibrosis
what is the renal presentation of SLE?
lupus nephritis
* can be asymptomatic
* monitored regularly - BP and urinalysis
what is the neurological presentation of SLE?
- seizures
- migraines
- peripheral neuropathies
- psychiatric symptoms - psychosis, depression, anxiety
cerebral lupus = unremitting headache + psychosis
what is the haematological presentation of SLE?
- anaemia of chronic disease
- lymphopenia
- autoimmune haemolytic anaemia
- thrombocytopenia
- leucopoenia
what is the GI presentations of SLE?
- peritonitis (aseptic)
- hepatosplenopmegaly
what conditions can arise secondary to SLE?
- secondary sjogren’s syndrome
- secondary anti-phospholipid syndrome
- mixed connective tissue disease
what is the typical presentation for drug-induced lupus (DIL)?
- triggered by chronic use of certain drugs for over one month
- systemic upsest
- arthritis (non-erosive) or arthralgia
- serositis - pleurisy or pericarditis
what drugs can cause drug-induced lupus?
- sulfadiazine
- hydralazine
- procainamide
- isoniazid
- methyldopa
- quinidine
- minocycline
- chlorpromazine
what investigations should be carried out in drug-induced lupus?
- autoantibodies = +ve ANA but -ve anti-dsDNA and anti-sm
- +ve anti-histone
- raised inflammatory markers
what investigations are carried out in suspected SLE?
- FBC and clotting screen
- U&Es and urinalysis
- ESR and CRP
- ANA, anti-dsDNA and anti-sm
- low complement (C3 and C4)
what tests are carried out to determine renal involvement in SLE?
- urinalysis
- renal ultrasound
- renal biopsy = diagnostic
what investigations is performed in suspected cerebral lupus?
brain MRI
what autoantibodies are seen in SLE?
- antinuclear antibodies (ANA) = sensitive not specific
- anti-dsDNA
- anti-sm
what mneomonic can be used to help diagnose SLE?
A RASH POINTs MD
Arthritis/arthralgia
Renal disease
ANA positive
Serositis (pericarditis/pleurisy/pleural effusion)
Haematological (haemolysis/low WCC/platelets/lymphocytes)
Photosensitivity rash
Oral ulcers
Immunological tests +ve
Neuropsychiatric
Malar rash
Discoid rash
present of >/= 4
what is the treatment for mild SLE?
NSAIDs + hydroxychloroquine
