Systemic Lupus Erythematosus

Question 1

Describe the Pathophysiology of LSE

Answer 1

Pathophysiology of SLE

• Primary issue: defect in apoptosis
• Dead cells are not cleared effectively, so nuclear antigens are exposed on the cell surface
• Nuclear antigens are taken up by antigen-presenting cells and B cells are activated
• Autoantibodies are generated against nuclear antigens
• The autoantigens form immune complexes, which deposit in tissues (mainly skin and kidneys) leading to complement activation, cytokine generation and widespread inflammation

Antinuclear antibodies (ANA)

• Seen in all SLE cases
• Not specific for SLE

Anti—double stranded DNA antibodies (anti-dsDNA)

• SLE specific
• Serum level correlates with disease severity

Anti-cardiolipin antibodies

Question 2

What are the general and specific features of LSE

Answer 2

General Features

1. Malaise
2. Fever
3. Weight loss
4. Lymphadenopathy

Specific Features

1. Butterfly rash
2. Alopecia
3. Arthralgia
4. Long history of Raynaud’s phenomenon

Question 3

What is the LSE managment?

Answer 3

• Diagnosis: antinuclear & anti-dsDNA antibodies, increased complement consumption, lymphopenia, leukopenia, proteinuria, haematuria

Treatment

• Mild (joints, skin involved)
  
  • Paracetamol, NSAIDs, hydroxychloroquine, topical corticosteroids
• Moderate (inflammation of other organs)
  
  • Corticosteroids (start with a High Dose)
• Severe (severe nephritis)
  
  • Azathioprine, cyclophosphamide, mycophenolate mofetil, rituximab and belimumab

Question 4

Define arthritis, arthralgia, subluxation, synovitis

Answer 4

1. Arthritis – definite inflammation of a joint(s)
2. Arthralgia – pain within a joint without demonstrable inflammation by physical examination
3. Dislocation – articulating surfaces are displaced and no longer in contact
4. Subluxation – partial dislocation
5. Synovitis – inflammation of the synovium

Question 5

What are the different patterns that Arthritis can take ?

Answer 5

1. Rheumatoid – bilateral, symmetrical, large and small joints
2. Osteoarthritis – weight-bearing joints, fingers, toes
3. Gout – mainly the 1st metatarsophalangeal joint
4. Reactive – lower limb, asymmetrical, oligoarthritis, axial involvement