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Musc > Systemic lupus erythematosus > Flashcards

Systemic lupus erythematosus Flashcards

1
Q

What is SLE

A

Systemic autoimmune disease

Chronic relapsing and remitting

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2
Q

What is the genetic association

A

Unknown aetiology –multi-factorial genetic

(HLA-DR3)

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3
Q

What systems are are invoved in the pathology

A 
Mutli-system:
CNS            
Heart 
Kidney        
Blood 
Heart           
Skin and Joints
Foetus         
Lungs
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4
Q

Who are most likely to get lupus

A

Most likely Female (10:1 ratio)
Probably young when started (age of onset15-47)
Increased risk in Afro-Caribbean/Asian

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5
Q

Outline the pathogenesis

A

Innate susceptibility (HLA type/immunoregulatory genes/ complement/hormones)
+
Environmental stimuli

Leads to

Autoimmune proliferation and
autoantibody production

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6
Q

T/F- anti-nuclear antibodies is diagnostic of lupus

A

F….. up to 5% of population have this

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7
Q

Outline the stages leading to SLE

A

A. Loss of self-tolerance

B. Production of auto-antibody

C. Desposition of immune complexes

D. Immune complex inflammation

E. Tissue fibrosis and damage

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8
Q

What happens in loss of self tolerance

A

Failure to clear apoptotic cells, exposing nuclear antigens to immune system

APCs such as DCs take up nuclear antigens, they are recognised internally by TLRs

APC may present the self-antigen to autoreactive cell

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9
Q

What happens in production of autoantibody

A

Pathomnemonic

Autoreactive T cells provide help to B cells, producing large quantities of autoantibody

The antibodies form immune complexes

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10
Q

What happens with deposition of immune complexes

A

Circulating ICs not cleared and become deposited in tissues like kidney or skin

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11
Q

What happens in immune complex associated inflammation

A

IC deposited in tissues not cleared, and elicit inflammation with complement activation (classical pathway) and activation of macrophaes and neutrophils via surface Fc receptors which bind IgG

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12
Q

What happens in fibrosis and damage

A

Production of pro-inflammatory and pro-fibrotic cytokines. Leads to irreversible tissue damage

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13
Q

Clinical features of SLE:

Presentation

A

Malaise, fatigue, fever, wt loss

Lymphadenopathy

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14
Q

Clinical features of SLE:

Specific features of SLE

A
  • Butterfly rash (=malar rash), alopecia
  • Arthralgia
  • Raynaud’s phenomenon
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15
Q

Clinical features of SLE:

A
  • Inflammation kidney, CNS, heart, lung
  • Accelerated atherosclerosis
  • Vasculitis
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16
Q

SLE criteria

A

Use the ACR criteria

S-Serositis
O-oral ulcers
A-arthritis
P-Photosensitivity

B-Blood (all low)
Renal-proteinuria
Immunological- ANA, anti-dsDNA
N-neurological-seizures/psychosis

M-Malar rash
D- discoid rash

17
Q

Differential diagnosis with SLE

A

ANA positive due to infection/malignancy

Other autoimmune CTD

Cutaneous SLE- without systemic involvement

Drug induced Lupus-

18
Q

Drugs inducing lupus

A

procanamide, hydrazine, quinidine, isonizaide

19
Q

How is SLE diagnosed

A

ANA antibodies

Other

Haem

Renal

20
Q

What diseases associated with thedollowing antinuclear body patterns

Homogenous
Speckled
Nucleolar
Fine speckled

A

Homogenous: Abs to DNA …. SLE

Speckled- Abs to Ro, La, Sm, RNP… SLE/overlap

Nucleolar- Abs to topoisomerase….. scleroderma

Fine speckled- Abs to Centromere… CREST (limited custanous scleroderma

21
Q

Other than ANAs what other antibodies might you check

A

Anti-dsDNA and Sm more specific for SLE but less sensitive

Anti-Ro and/or Lo- common in subacute cutaneous LE. Neonatal lupus syndrome and Sjorens

22
Q

Outline ‘other tests’ for SLE

A
  • Increased complement consumption
  • Anti-cardiolipin antibodies
  • Lupus anticoagulant
  • ß1 glycoprotein
23
Q

Haematology lab tests in SLE

A
  • Lymphopaenia, normochromic anaemia

* Leukopaenia, AIHA, thrombocytopaenia

24
Q

Renal lab tests in SLE

A

Proteinuria, haematuria

Active urinary sediment

25
Q

How is severeity of SLE assessed

A
  1. Identify pattern of organ involvement
  2. Monitor function of affected organs
  • Renal
  • Lungs/CVS -
  • Skin, haematology, eyes
  1. Identify pattern of autoantibodies expressed
  • Anti-dsDNA, anti-Sm - renal disease
  • Anti-cardiolipin antibodies
26
Q

What are the signs of disease activity in SLE

A
  • Wt loss, fatigue, malaise, hair loss
  • Alopecia
  • Rash
27
Q

What are the lab diagnoses of disease activity in SLE

A
  • ESR
  • Increased complement consumption
  • Increased anti-dsDNA
  • Other Abs e.g ANA and CRP poor indicators
28
Q

What is mild, moderate and severe SLE

A

MILD:
-joint +/- skin involvement

MODERATE:

  • inflammation of other organs
  • pleuritis, pericarditis, mild nephritis

SEVERE:
-sever inflammation in vital organs: sever nephritis, CNS disease, pulmonary disease, cardiac involvemnet, thombcytopenia

29
Q

Treatment of mild SLE

A

Paracetemol +/- NSAID (monitor renla function)

Hydroxychloroquine (in arthropathy, cutaneous manifestations and mild diseases activity)

Topical corticosteroids

30
Q

Treatment of severe SLE

A

Oral steroids or IV methylprednisolone

+ Immunosupressants- severe organ disease

  • Cyclophosphamide
  • Mycofenalate Mofitil (MMF)
  • Rituximab (anti-CD20 monoclonal anti-body) for Lupus Nephritis

Maintenance treatment with low dose oral steroids (<5mg/day) and immunosuppressants (methotrexate, azathioprine or MMF)

31
Q

Why do lupus patients need sun bock

A

lupus is very photosensitive

32
Q

What if lupus patuets get pregnant

A

Anti-RO antibodies in pregnancy- need to be monitored due to risk of congenital HB

33
Q

When is hydroxychloroquine used?

A

Hydroxychloroquine commonly used for skin and joint disease

34
Q

Prognosis and survival of lupus

A

15 year survival : no nephritis 85%

nephritis 60%

35
Q

When is prognosis worse in lupus

A

Prognosis also worse if black, male,

low socio-economic status

36
Q

What is going to be causig mortality in SLE

A

Early mortality:

Active lupus

  • Renal failure
  • CNS disease
  • Infection
Late mortality: 
Myocardial infarction (due to accelerated atherosclerosis)
37
Q

Overal treatment strategies for SLE

A

Symptomatic
Immune-modulating
Immunosuppressive

38
Q

What do the clinical features of SLE depends on

A

Organ affected

Musc (12 decks)

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