Systemic Lupus Erythematosus Flashcards
What is systemic lupus erythematosus?
- inflammatory autoimmune connective tissue disorder
- inadequate T cell suppressor activity with increased B cell activity
- erythematosus refers to malar rash across face
What is the pathophysiology of SLE?
- Characterised by anti nuclear antibiodies ANA
- ANA are autoantibodies against proteins within cell nuclei
- this generates a chronic inflammatory response
Typical demographic of SLE
- women
- African, Caribbean, Asian or Hispanic ethnicity
- young-middle age
Presentation of SLE
A RASh POINts Medical Diagnosis
- ANA positive
- Renal abnormalities > oedema
- Arthritis/arthlagia
- Scalp changes - hair loss
- Photosensititve malar rash
- Oral ulcers
- Immunological abnormalities
- Neurological abnormalities
- Malar rash / Discoid rash
.
- weight loss
- fatigue
- pleuritic chest pain
- Raynaud’s phenomenon
Investigations of SLE
- autoantibodies (ANA)
- FBC - anaemia of chronic disease, low white cell + thrombocytopenia
- C3+C4 fall with active disease
- urinalysis, ACR, renal biopsy - lupus nephritis
- ESR raised
- plasma viscosity raised
Management of SLE
- sun protection/avoidance
- lifestyle advice due to cardiovascular risk
- first line drugs: hydroxychloroquine, NSAIDs + steroids
- for more severe SLE: DMARDs e.g. methotrexate, mycophenolate mofetil + biological therapies e.g. rituximab + belimumab
First line drug treatment of SLE
hydroxychloroquine
NSAIDs
Steroids e..g prednisolone
Complications of SLE
- increased CVD risk
- infection risk
- anamia of chronic disease
- low white cells, neutrophils + platelets
- pericarditis
- interstitial lung disease > pulmonary fibrosis
- lupus nephritis
- miscarriage
- optic neuritis
What features might suggest active disease (a flare up) of SLE?
- decreased C3 + C4
- worsening of symptoms
- increased ESR
What monitoring is required when using SLE treatment long term?
FBC
LFTs
U&Es
Antibodies in SLE
- ANA
- anti-dsDNA
- anti-smith
- can have RF
Most common renal complication of SLE
Diffuse proliferative glomerulonephritis
What is discoid lupus erythematosus
benign disorder typically in younger females
Presentation is discoid lupus erythematosus
- erythematous raised discoid rash
- most common on face, neck, ears, scalp
- scarring alopecia
Management of discoid lupus erythematosus
- topical steroid cream first line
- hydroxychloroquine second line
- avoid sun exposure
Causes of drug induced lupus
- procainamide
- hydralazine
- isoniazid
- phenytoin
Features of drug induced lupus
- arthralgia
- myalgia
- malar rash
- pleurisy
- ANA +
Antibodies in drug induced lupus
- ANA positive
- dsDNA negative
- anti-histone antibodies positive
Where does SLE malar rash spare?
Nasolabial rash
