Systemic Lupus Erythematosus Flashcards
What is systemic lupus erythematosus (SLE)?
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
Which hypersensitivity reaction is associated with systemic lupus erythematosus?
Type III
What four risk factors are associated with systemic lupus erythematosus?
Young Age, 20 – 40 Years Old
Female Gender
Afro-American Ethnicity
Family History
What are the two genes associated with systemic lupus erythematosus?
HLA-DR2
HLA-DR3
What are the fourteen clinical features of systemic lupus erythematosus?
Fever
Fatigue
Dyspnoea
Pleuritic Chest Pain
Pericarditis
Malar Rash
Discoid Rash
Arthralgia
Myalgia
Mouth Ulceration
Raynaud’s Phenomenon
Scarring Alopecia
Lymphadenopathy
Weight Loss
What is the most common clinical feature of systemic lupus erythematosus?
Malar Rash
Describe the malar rash associated with systemic lupus erythematosus
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
Describe the discoid rash associated with systemic lupus erythematosus
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
What two investigations are used to diagnose systemic lupus erythematosus?
Blood Tests
Urinalysis
What eleven blood test results indicate systemic lupus erythematosus?
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
What is the first line blood test used to diagnose systemic lupus erythematosus?
Anti-Nuclear Antibodies (ANA)
What is the most sensitive blood test of systemic lupus eyrthematosus? What does this mean?
Anti-Nuclear Antibodies (ANA)
This means that there are few false negative results
What is the most specific blood test of systemic lupus eyrthematosus? What does this mean?
Anti-dsDNA
This means that there are few false positive results
What two urinalysis results indicate systemic lupus erythematosus?
Haematuria
Proteinuria
What investigation is used to monitor disease progression of systemic lupus erythematosus? Explain
Complement Levels
They are decreased during active disease, due to the formation of complexes leading to consumption of complement
What is the diagnostic criteria of systemic lupus erythematosus?
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
What are the four conservative management options of systemic lupus erythematosus?
Sun Avoidance
High SPF Sunscreen
Smoking Cessation
Regular Exercise
What are the four pharmacological management options of mild systemic lupus erythematosus?
NSAIDs
Prednisolone
Hydroxychloroquine
Methotrexate
What is the gold standard management option of systemic lupus erythematosus - which should be administered in all cases?
Hydroxychloroquine
What is a side effect of hydroxychloroquine?
Retinopathy
What are the three clinical features of hydroxycloroquine induced retinopathy?
Photophobia
Flashing Lights
Decreased Visual Acuity
What is the feature of hydroxychloroquine induced retinopathy on fundoscopy?
There is central depigmentation of a macula, surrounded by thin speckled rings of hyperpigmentation
How do we prevent hydroxychloroquine induced retinopathy?
When individuals are administered hydroxychloroquine > 5 years, we conduct annual visual acuity tests and fundoscopy
What are the four pharmacological management options of moderate systemic lupus erythematosus?
Prednisolone
Azathioprine
Mycophenolate Mofetil
Cyclosporine
What are the four pharmacological management options of severe systemic lupus erythematosus?
Prednisolone
Cyclophosphamide
Rituximab
Belimumab
What are the eleven complications associated with systemic lupus erythematosus?
Permanent Skin Damage
Atherosclerosis
Pericarditis
Pleuritis
Interstitial Lung Disease
Lupus Nephritis
End-Stage Renal Disease
Autoimmune Haemolytic Anaemia
Antiphospholipid Syndrome
Blindness
Miscarriage
What are the three clinical features of lupus nephritis?
Polyuria
Foamy Urine
Peripheral Oedema
What is the feature of lupus nephritis on urinalysis?
Proteinuria
