Systemic Lupus Erythematosus Flashcards
What is SLE?
Systemic autoimmune disease
Can affect any part of the body
What is the gender distribution of SLE?
M:F ratio is 1:9
How does race affect prevalence of SLE?
Higher in Asians, Afro Americans, Hispanic Americans, Caribbeans
Rare in black Africans
What factors affect the development of SLE?
Genes Hormones: incidence higher with exposure to oestrogen Viral infections UV light Smoking/silica powder
Describe the pathogenesis of SLE
Increased apoptosis
Defective clearance of cell debris leaves cell materials lingering
Increased exposure may lead to antigen formation against these self proteins - autoimmunity
B and T cells are stimulated
Autoantibodies are formed
Name 5 constitutional symptoms of SLE
Fatigue! Malaise Poor appetite Weight loss Fever
Name 6 mucocutaneous features of SLE
Photosensitivity Malar rash Discoid lupus erythematosus Alopecia Mouth ulcers Raynaud's syndrome
Name 4 MSK features of SLE
Arthralgia RARELY deforming or erosive
Myalgia
Inflammatory arthritis
Avascular necrosis (femoral head)
Name 4 pulmonary features of SLE
Pleurisy
Infections
Pleural effusions and fibrosis
Pulmonary hypertension and infarction
Name 4 cardiac features of SLE
Pericarditis
Cardiomyopathy
Libman-Sachs endocarditis (sterile)
Name the renal feature of SLE and its presentation
Glomerulonephritis
- proteinuria
- hypertension
- acute (or chronic) renal failure
How is glomerulonephritis associated with SLE detected?
Active investigation
Signs aren’t apparent until very late on
Name 4 neurologic features of SLE
Depression/psychosis
Migraines
Stroke/TIAs
Cranial/peripheral neuropathy
Name 4 haematological features of SLE
Lymphadenopathy
Leukopaenia
Anaemia
Thrombocytopenia
Which 2 tests must be done to check for SLE?
FBC
Renal function & urinalysis
What are we looking for in a urinalysis in terms of SLE?
Anti-nuclear antibody
Anti-double stranded DNA antibodies
ENA
Complement levels
Which antibody concentration varies positively with SLE disease activity in the body?
Anti-double stranded DNA
- highly specific for SLE
Which antibody is associated with cutaneous features of SLE?
Anti-Ro
- also associated with Anti-La
Which inflammatory components vary negatively with SLE disease activity?
C3 and C4
What danger does SLE pose to pregnant women?
Risk of pre-eclampsia
Which 3 drugs are used to treat skin disease and arthralgia in (mild) SLE?
Hydroxychloroquine
Topical steroids
NSAIDs
Which 3 drugs are used to treat inflammatory arthritis in SLE?
Oral steroids
Azathioprine
Methotrexate
What type of drugs are used to treat organ disease e.g. CNS lupus in severe SLE?
IV steroids
Cyclophosphamide.
What is used to treat refractory SLE?
Biologics
- rituximab
What type of hypersensitivity reaction causes visceral lesions in SLE?
Type III
What type of hypersensitivity reaction causes haematological effects in SLE?
Type II
