Systemic lupus erythematosus

Question 1

Typical demographic

Answer 1

females (F:M = 9:1)
Afro-Caribbeans* and Asian communities
age 20-40 years

Question 2

What type of hypersensitivity reaction is SLE?

Answer 2

type 3 hypersensitivity reaction

Question 3

HLA associations

Answer 3

HLA B8, DR2, DR3

Question 4

General Features

Answer 4

fatigue
fever
mouth ulcers
lymphadenopathy

Question 5

Skin features

Answer 5

• malar (butterfly) rash
• discoid rash (Lesions may become pigmented and hyperkeratotic before becoming atrophic)
• photosensitivity
• Raynaud’s phenomenon
• livedo reticularis
• non-scarring alopecia

Question 6

MSK features

Answer 6

arthralgia
non-erosive arthritis

Question 7

Cardiovascular features

Answer 7

pericarditis (most common)
myocarditis

Question 8

Renal features

Answer 8

proteinuria
glomerulonephritis (diffuse proliferative glomerulonephritis = most common type)

Question 9

Respiratory features

Answer 9

pleurisy
fibrosing alveolitis

Question 10

Neuropsychiatric features

Answer 10

anxiety and depression
psychosis
seizures

Question 11

Antibody which is often positive in Lupus but has low specificity

Answer 11

ANA

Question 12

Antibodies which are positive with high specificity

Answer 12

Anti-dsDNA
Anti-Smith

Question 13

Other autoantibodies which may be positive

Answer 13

RF
anti-U1 RNP
anti-Ro
anti-La

Question 14

What is used to measure disease activity?

Answer 14

complement levels (C3, C4)
- LOW during active disease (formation of complexes leads to consumption of complement)

Question 15

Management of SLE

Answer 15

NSAIDs
sun-block
Hydroxychloroquine

If internal organ involvement e.g. renal, neuro, eye then consider prednisolone, cyclophosphamide

Question 16

SLE related preganncy complication

Answer 16

• maternal autoantibodies may cross placenta (usually Anti-Ro)
  => neonatal lupus erythematosus
  => complications include congenital heart block