Systemic Lupus Erythematosus

Question 1

What are the risk factors of SLE?

Answer 1

• Female
• age 15 - 45
• African/Asian decent

Question 2

Pathophysiology of SLE

Answer 2

IgG antibodies to dsDNA and nuclear (ANA = anti nuclear antibodies)

Question 3

What are the three main rashes that occur in SLE?

Answer 3

• Malar rash: erythema over the cheeks and bridge of nose, sparing the nasolabial folds
• Photosensitive rash: Rash occurs after sun exposure. It can be painful and pruritic and usually lasts a few days, healing without scarring
• Discoid rash: Erythematous raised patches with adherent keratotic scaling and follicular plugging. This is the chronic rash

Question 4

Outline the articular features of SLE

Answer 4

Non - destructive, non-deforming polyarthritis i.e. REVERSIBLE (with fist, prayer and reverse prayer)

Question 5

What are the common extra-articular features of SLE?

Answer 5

• The 3 rashes: malar, photosensitive and discoid
• Fatigue
• Weight loss
• Fever
• Oral ulcers
• Pleuritis and pericarditis (serositis)
• Renal impairment (proteinuria)
• Alopecia
• Fibromyalgia
• Raynaud’s Phenomenon
• HTN
• abdo pain, n/v

Question 6

How do we diagnose SLE?

Answer 6

Clinical picture
FBE: anaemia, leukopaenia, thrombocytopaenia
Serology: ANA, anti-dsDNA
ESR and CRP elevated
Urinalysis: protein, red casts

Question 7

What is the 1st line treatment of SLE, its adjuncts and other options in progressing disease?

Answer 7

1st line: NSAIDs + lifestyle changes

• Naproxen (main)
• Stop smoking, sun protection, exercise

Adjunct: Hydroxychloroquine

Adjunct: Corticosteroids
Predinisolone orally 5-40mg od

Adjunct: Methotrexate and folic acid