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Year Two - Rheumatology > Systemic Lupus Erythematosus > Flashcards

Systemic Lupus Erythematosus Flashcards

1
Q

What is systemic lupus erythematosus (SLE)?

A

It is defined as a complex multisystem autoimmune condition, in which hypersensitivity reactions result in the formation of autoantibodies against cell nuclear autoantigens

This leads to the deposition of immune complexes throughout the body

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2
Q

Which hypersensitivity reaction is associated with systemic lupus erythematosus?

A

Type III

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3
Q

What four risk factors are associated with systemic lupus erythematosus?

A

Young Age, 20 – 40 Years Old

Female Gender

Afro-American Ethnicity

Family History

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4
Q

What are the two genes associated with systemic lupus erythematosus?

A

HLA-DR2

HLA-DR3

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5
Q

What are the fourteen clinical features of systemic lupus erythematosus?

A

Fever

Fatigue

Dyspnoea

Pleuritic Chest Pain

Pericarditis

Malar Rash

Discoid Rash

Arthralgia

Myalgia

Mouth Ulceration

Raynaud’s Phenomenon

Scarring Alopecia

Lymphadenopathy

Weight Loss

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6
Q

What is the most common clinical feature of systemic lupus erythematosus?

A

Malar Rash

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7
Q

Describe the malar rash associated with systemic lupus erythematosus

A

It is pruritic, with a butterfly appearance affecting the nasal bridge and cheeks - spraing the nasolabial folds

It is photosensitive, which means that it is exacerbated by sunlight

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8
Q

Describe the discoid rash associated with systemic lupus erythematosus

A

It is scaly, erythematous and well-demarcated - which tends to occur in sun-exposed areas

The lesions may progress to become pigmented and hyperkertoic, before becoming atrophic

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9
Q

What two investigations are used to diagnose systemic lupus erythematosus?

A

Blood Tests

Urinalysis

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10
Q

What eleven blood test results indicate systemic lupus erythematosus?

A

Decreased Haemoglobin Levels

Normal MCV Levels

Decreased WBC Levels

Decreased Platelet Levels

Increased ESR Levels

Increased CRP Levels

Decreased C3/C4 Levels

Positive Anti-Nuclear Antibodies (ANA)

Positive Anti-Smith Antibodies

Positive Anti-dsDNA Antibodies

Positive Antiphospholipid Antibodies

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11
Q

What is the first line blood test used to diagnose systemic lupus erythematosus?

A

Anti-Nuclear Antibodies (ANA)

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12
Q

What is the most sensitive blood test of systemic lupus eyrthematosus? What does this mean?

A

Anti-Nuclear Antibodies (ANA)

This means that there are few false negative results

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13
Q

What is the most specific blood test of systemic lupus eyrthematosus? What does this mean?

A

Anti-dsDNA

This means that there are few false positive results

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14
Q

What two urinalysis results indicate systemic lupus erythematosus?

A

Haematuria

Proteinuria

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15
Q

What investigation is used to monitor disease progression of systemic lupus erythematosus? Explain

A

Complement Levels

They are decreased during active disease, due to the formation of complexes leading to consumption of complement

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16
Q

What is the diagnostic criteria of systemic lupus erythematosus?

A

The individual must meet four criteria, with at least one clinical and one immunological criterion fulfilled

However, lupus nephritis in the presence of anti-nuclear antibodies or anti-dsDNA antibodies is also sufficient for diagnosis

17
Q

What are the four conservative management options of systemic lupus erythematosus?

A

Sun Avoidance

High SPF Sunscreen

Smoking Cessation

Regular Exercise

18
Q

What are the four pharmacological management options of mild systemic lupus erythematosus?

A

NSAIDs

Prednisolone

Hydroxychloroquine

Methotrexate

19
Q

What is the gold standard management option of systemic lupus erythematosus - which should be administered in all cases?

A

Hydroxychloroquine

20
Q

What is a side effect of hydroxychloroquine?

A

Retinopathy

21
Q

What are the three clinical features of hydroxycloroquine induced retinopathy?

A

Photophobia

Flashing Lights

Decreased Visual Acuity

22
Q

What is the feature of hydroxychloroquine induced retinopathy on fundoscopy?

A

There is central depigmentation of a macula, surrounded by thin speckled rings of hyperpigmentation

23
Q

How do we prevent hydroxychloroquine induced retinopathy?

A

When individuals are administered hydroxychloroquine > 5 years, we conduct annual visual acuity tests and fundoscopy

24
Q

What are the four pharmacological management options of moderate systemic lupus erythematosus?

A

Prednisolone

Azathioprine

Mycophenolate Mofetil

Cyclosporine

25
Q

What are the four pharmacological management options of severe systemic lupus erythematosus?

A

Prednisolone

Cyclophosphamide

Rituximab

Belimumab

26
Q

What are the eleven complications associated with systemic lupus erythematosus?

A

Permanent Skin Damage

Atherosclerosis

Pericarditis

Pleuritis

Interstitial Lung Disease

Lupus Nephritis

End-Stage Renal Disease

Autoimmune Haemolytic Anaemia

Antiphospholipid Syndrome

Blindness

Miscarriage

27
Q

What are the three clinical features of lupus nephritis?

A

Polyuria

Foamy Urine

Peripheral Oedema

28
Q

What is the feature of lupus nephritis on urinalysis?

A

Proteinuria

Year Two - Rheumatology (8 decks)

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