Systemic lupus erythematosus

Question 1

Signs of SLE

Answer 1

Serositis - pleura and pericardium 
Oral ulcers
Arthritis (poly)
Photosensitivity 
Blood disorders - antiphospholipid syndrome and haemolytic anaemia 
Renal - proteinuria or RBC casts 
Anti-dsDNA specific and ANA sensitive 
Immunology - leukopenia and thrombocytopenia 
Neurology - seizures and psychosis
Malar rash (acute cutaneous lupus)
Discoid rash (chronic cutaneous lupus)

Question 2

Treatment for acute SLE

Answer 2

Mild: oral low dose prednisolone or hydroxychloroquine
Moderate (organ damage): DMARDs or mycophenolate
Severe (life threatening organ damage): high dose steroids, mycophenolate, rituximab, cyclophosphamide

Question 3

Treatment for maintaining SLE remission

Answer 3

NSAIDs
Hydroxychloroquine
Monoclonal antibody as add on if autoantibody positive

Question 4

Describe antiphospholipid syndrome

Answer 4

CLOT:
Clotting
Lavido reticularis
Obstetric - recurrent miscarriages
Thrombocytopenia

Question 5

Investigations for SLE

Answer 5

FBC
LFTs
Us and Es
CRP - usually normal
ESR
Anti-dsDNA
ANA
Complement - decreases in SLE 
Urine dipstick

Question 6

More common demographic for SLE

Answer 6

Women
Child bearing age
Afro-Caribbean or Asian

Question 7

What causes drug induced lupus

Answer 7

Isoniazid
Hydralazine
Procainamide
Phenytoin
Quinidine
Anti-TNF

Question 8

What drugs may exacerbate idiopathic SLE

Answer 8

Oral contraceptive pill

Sulphonamides (antimicrobial)

Question 9

Treatment for lupus nephritis

Answer 9

Class 1/2: ACEi for renal protection, hydroxychloroquine for extrarenal disease

Class 3/4: cyclophosphamide, mycophenolate, rituximab, high dose steroids. May need RRT

Question 10

Minimum to diagnose SLE

Answer 10

At least 4 clinical criteria
AND
At least 1 laboratory criteria