Systemic Lupus Erythematosus

Question 1

Definition

Answer 1

Multi-system inflammatory autoimmune disorder

Question 2

Diagnostic criteria

Answer 2

• 4/11 of the diagnostic criteria of the American College of Rheumatology provides high sensitivity and specificity for the diagnosis of SLE: SOAP BRAIN MD

o Serositis
o Oral ulcers
o Arthritis (non-erosive)
o Photosensitivity
o Bloods (haemolytic anaemia/leukopaenia/thrombocytopaenia)
o Renal disease (urine casts/proteinuria)
o ANA
o Immunological disorder (anti-dsDNA/anti-Sm/anti-phospholipid)
o Neurological disease (psychosis/seizures)
o Malar rash
o Discoid rash

Question 3

Aetiology

Answer 3

• UNKNOWN
• Tissue damage may be caused by vascular immune complex deposition
• Could be due to a combination of hormonal, genetic and exogenous factors

Question 4

Epidemiology

Answer 4

• COMMON
• 1-2/1000
• More common in the YOUNG
• More common in AFRO-CARIBBEAN and CHINESE
• 9 x more common in FEMALES

Question 5

Presenting symptoms (general)

Answer 5

o Fever
o Fatigue
o Weight loss
o Lymphadenopathy
o Splenomegaly

Question 6

Presenting symptoms (other)

Answer 6

• Raynaud’s phenomenon
• Oral ulcers

• Skin Rash
o Malar rash
o Discoid lupus (red scaly patches)
o Atypical rashes (e.g. photosensitivity, vasculitis, urticaria, purpura)

Question 7

Presenting symptoms (systemic)

Answer 7

o Musculoskeletal - arthritis, tendonitis, myopathy

o Heart - pericarditis, myocarditis, arrhythmias, Libman-Sacks endocarditis

o Lung - pleurisy, pleural effusion, basal atelectasis, restrictive lung defects

o Neurological - headache, stroke, cranial nerve palsies, confusion, chorea

o Psychiatric - depression, psychosis

o Renal - glomerulonephritis

Question 8

Investigations (bloods)

Answer 8

o FBC
o U&E
o LFT
o Raised ESR
o Normal CRP
o Clotting
o Complement

Question 9

Investigations (autoantibodies)

Answer 9

o Anti-dsDNA (60%)
o Rheumatoid factor (30-50%)
o Anti-ENA
o Anti-RNP
o Anti-SM
o Anti-Ro
o Anti-La
o Anti-histone
o Anti-cardiolipin

Question 10

Investigations (other)

Answer 10

• Urine - haematuria, proteinuria, red cell casts
• Joints - plain radiographs
• Heart and Lungs - CXR, ECG, echocardiogram, CT
• Kidneys - renal biopsy (if glomerulonephritis suspected)
• CNS - MRI scan, lumbar puncture