Systemic Lupus Erythematosus Flashcards
What is systemic lupus erythematosus (SLE)?
Multi system autoimmune disease. Type 3 hypersensitivity reactions. It is more common in females and afro-carribean origin
What is the pathophysiology of SLE?
It is characterised by the presence of anti-nuclear antibodies. These attack a persons own cell nuclei causing inflammation
What are the general symptoms of SLE?
Fatigue, fever, mouth ulcers, lymphadenopathy.
What are the skin presentations of SLE?
- Malar (butterfly) rash which spares nasolabial folds.
- Discoid rash (round, raised papules)
- Hair loss,
- Cutaneous vasculitis,
- Livedo reticularis (salami skin which you can also get from being cold)
What is discoid lupus erythematosus?
Non cancerous skin condition which presents with a discoid rash but no other symptoms of SLE. Patient’s are at greater risk of developing SLE.
What is the MSK presentation of SLE?
- Arthralgia,
- Non-erosive arthritis
What are the cardiovascular presentations of SLE?
- Pericarditis (most common cardiac feature)
- Myocarditis
- Raynaud’s phenomenon,
- Increased risk of cardiovascular disease
What are the respiratory presentations of SLE?
- Pleurisy and pleural effusions
- Pneumonitis
- Fibrosing alveolitis
What is the renal presentation of SLE?
Lupus nephritis so must monitor via regular BP checks and urinalysis.
Glomerulonephritis
Treat with steroids and then mycophenolate
What is the neuropsychiatric presentation of SLE?
- Anxiety and depression,
- Psychosis,
- Seizure,
- Migraines,
- Peripheral neuropathy
What is the haematological presentation of SLE?
Anaemia of chronic disease (common)
Lymphopenia (common),
Autoimmune haemolytic anaemia
What are some conditions patients with SLE can often develop?
- Secondary sjogren’s,
- Secondary anti-phospholipid syndrome,
- Mixed connective tissue disease
What are the symptoms of drug induced lupus and some causes?
- Symptoms are systemic upset, arthritis/arthralgia, serositis
- Causes include suladiazine, hydralazine, isoniazid
What are the investigations for suspected SLE?
- FBC and clotting screen,
- UEs,
- ESR and CRP
- Antibodies: Anti-nuclear antibodies (not specific), anti-double stranded DNA (Anti-dsDNA - specific for SLE) and Anti-Smith antigen
- Compliment (low C3 and C4)
What antibody is seen in drug induced Lupus?
anti-histone antibodies
What are some triggers for SLE flares?
- Oestrogen containing contraception,
- Overexposure to sunlight,
- Infections,
- Stress
What is the pharmacological managament of SLE?
NSAIDs and Hydroxychloroquine. (Steroids for flares)
Severe flares causing internal organ involvement then consider pred and cyclophosphamide
What should always be done in a patient with SLE?
URINE DIP
What should always be done in a patient with SLE?
URINE DIP
What are some symptoms of cerebral lupus?
It can be varies: Fits, psychosis, headaches, impaired conciousness.
What is the GI presentation of SLE?
While uncommon it can present with: dysphagia, reduced peristalsis, peritonitis, pancreatitis, pseudo-obstruction and lupus hepatitis
What is antiphospholipid syndrome
Acquired disorder which can be primary but commonly associated with SLE.
Explain the presentation of antiphospholipid syndrome
- Venous/arterial thrombosis,
- Recurrent misscarriages,
- Levido reticualris
- Pre-eclampsia, pulmonary hypertension
What are the investigations for antiphospholipid syndrome?
- Antibodies: Anticardiolipin antibodies, anti-beta2 glycoprotein and lupus anticoagulant.
- Thrombocytopenia
- Paradoxical rise in APTT
What is the management of antiphospholipid syndrome?
Primary thrombophrophylaxis - Low dose aspirin
Secondary thromboprophylaxis - Initial VTE then warfarin with INR of 2-3. Recurrent VTE then warfarin with INR of 3-4. Arterial thrombosis then INR 2-3
