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Phase 4 Rheumatology > Systemic Lupus Erythematosus > Flashcards

Systemic Lupus Erythematosus Flashcards

1
Q

What is systemic lupus erythematosus (SLE)?

A

Multi system autoimmune disease. Type 3 hypersensitivity reactions. It is more common in females and afro-carribean origin

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2
Q

What is the pathophysiology of SLE?

A

It is characterised by the presence of anti-nuclear antibodies. These attack a persons own cell nuclei causing inflammation

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3
Q

What are the general symptoms of SLE?

A

Fatigue, fever, mouth ulcers, lymphadenopathy.

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4
Q

What are the skin presentations of SLE?

A
  • 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)
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5
Q

What is discoid lupus erythematosus?

A

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.

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6
Q

What is the MSK presentation of SLE?

A
  • Arthralgia,
  • Non-erosive arthritis
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7
Q

What are the cardiovascular presentations of SLE?

A
  • Pericarditis (most common cardiac feature)
  • Myocarditis
  • Raynaud’s phenomenon,
  • Increased risk of cardiovascular disease
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8
Q

What are the respiratory presentations of SLE?

A
  • Pleurisy and pleural effusions
  • Pneumonitis
  • Fibrosing alveolitis
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9
Q

What is the renal presentation of SLE?

A

Lupus nephritis so must monitor via regular BP checks and urinalysis.
Glomerulonephritis

Treat with steroids and then mycophenolate

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10
Q

What is the neuropsychiatric presentation of SLE?

A
  • Anxiety and depression,
  • Psychosis,
  • Seizure,
  • Migraines,
  • Peripheral neuropathy
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11
Q

What is the haematological presentation of SLE?

A

Anaemia of chronic disease (common)
Lymphopenia (common),
Autoimmune haemolytic anaemia

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12
Q

What are some conditions patients with SLE can often develop?

A
  • Secondary sjogren’s,
  • Secondary anti-phospholipid syndrome,
  • Mixed connective tissue disease
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13
Q

What are the symptoms of drug induced lupus and some causes?

A
  • Symptoms are systemic upset, arthritis/arthralgia, serositis
  • Causes include suladiazine, hydralazine, isoniazid
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14
Q

What are the investigations for suspected SLE?

A
  • 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)
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15
Q

What antibody is seen in drug induced Lupus?

A

anti-histone antibodies

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16
Q

What are some triggers for SLE flares?

A
  • Oestrogen containing contraception,
  • Overexposure to sunlight,
  • Infections,
  • Stress
17
Q

What is the pharmacological managament of SLE?

A

NSAIDs and Hydroxychloroquine. (Steroids for flares)
Severe flares causing internal organ involvement then consider pred and cyclophosphamide

18
Q

What should always be done in a patient with SLE?

A

URINE DIP

19
Q

What should always be done in a patient with SLE?

A

URINE DIP

20
Q

What are some symptoms of cerebral lupus?

A

It can be varies: Fits, psychosis, headaches, impaired conciousness.

21
Q

What is the GI presentation of SLE?

A

While uncommon it can present with: dysphagia, reduced peristalsis, peritonitis, pancreatitis, pseudo-obstruction and lupus hepatitis

22
Q

What is antiphospholipid syndrome

A

Acquired disorder which can be primary but commonly associated with SLE.

23
Q

Explain the presentation of antiphospholipid syndrome

A
  • Venous/arterial thrombosis,
  • Recurrent misscarriages,
  • Levido reticualris
  • Pre-eclampsia, pulmonary hypertension
24
Q

What are the investigations for antiphospholipid syndrome?

A
  • Antibodies: Anticardiolipin antibodies, anti-beta2 glycoprotein and lupus anticoagulant.
  • Thrombocytopenia
  • Paradoxical rise in APTT
25
Q

What is the management of antiphospholipid syndrome?

A

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

Phase 4 Rheumatology (16 decks)

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