Systemic Lupus Erythematosus

Question 1

Which gender does SLE more commonly affect?

Answer 1

Females 9:1

Question 2

Describe the presentation of SLE including some specific features.

Answer 2

Malaise, fatigue, weight loss, fever, lymphadenopathy  
Specific features:  
Butterfly rash
Alopecia  
Arthralgia  
Long history of Raynaud’s phenomenon

Question 3

Describe the pathogenesis of SLE.

Answer 3

SLE patients have a defect in apoptosis
Apoptotic cells are not cleared properly so they persist and expose their nuclear antigens and autoantibodies are generated against these nuclear antigens
The defect in apoptosis is combined with B cell hyperactivity
The overactive B cells are exposed to the nuclear antigens and the plasma cells begin to produce autoantibodies that circulate and form immune complexes
The immune complexes deposit in tissues and activate complement leading to inflammation

Question 4

What is the first investigation performed in the diagnosis of SLE?

Answer 4

Check for anti-nuclear antibodies (this is not specific for SLE though)

Question 5

What are some other tests that can be done for SLE?

Answer 5

Measuring complement levels

Question 6

What renal changes might occur in SLE?

Answer 6

Proteinuria
Haematuria
Active urinary sediment

Question 7

List some clinical features that could help pre-empt severe attacks in SLE.

Answer 7

Malaise, weight loss, alopecia, rash

Question 8

List some laboratory markers that could help pre-empt severe attacks in SLE.

Answer 8

Raised eryhtrocyte sedimentation rate (ESR)
Raised anti-dsDNA antibodies
Reduced complement levels

Question 9

Describe the differences between mild, moderate and severe disease in SLE.

Answer 9

Mild – skin and joint involvement
Moderate – inflammation of other organs (e.g. pleuritis, pericarditis)
Severe – severe inflammation of vital organs

Question 10

Describe the treatment of mild disease.

Answer 10

Paracetamol and NSAIDs
Hydroxychloroquine (good for arthropathy and cutaneous manifestations)
Topical corticosteroids

Question 11

Describe the treatment of moderate disease.

Answer 11

ORAL GLUCORTICOIDS

Start with a HIGH dose and titre downwards

Question 12

Describe the treatment of severe disease.

Answer 12

Azathioprine

Cyclophosphamide

Question 13

Name and explain the mechanism of action of two new treatments for SLE

Answer 13

Mycophenolate mofetil
Rituximab
Both affect lymphocyte proliferation

Question 14

SLE has and early peak and a late peak in mortality. What are the usual causes of the two peaks?

Answer 14

Early – renal failure, CNS disease, infection

Late – MI and stroke

Question 15

What do you test in renal function of SLE?

Answer 15

Proteinuria
Haematuria
Active urinary sediment