Systemic Lupus Erythematosus Flashcards
What is SLE?
multisystemic autoimmune inflammatory disorder fo connective tissues
What are the leading causes of mortality in SLE?
- Chronic Renal Failure (first)
- infection
- CVD
What are the RF for SLE?
- F
- afro-caribbean
- Asians
- HLA B8
What is the pattern of clinical features of SLE?
- Relapsing (becomes more severe) and remitting (becomes less severe)
What type of hypersensitivity is SLE?
- Type 3 (immune Complex mediated)
What is the Px of SLE?
- B-cells produce anti nuclear antibodies
- Target nuclear antigens on cells - inflammatry response
- antibody-antigen complex formed and stick to vessel walls of skin, kidneys, heart, joints
- Deposition of complexes initiate local inflammation to occur
What are the 11 key findings of SLE?
*remember the 4 groups (skin, membranes, extraglandular, blood)
- Skin (rashes appear after sun exposure)
- Malar rash - nasolabial fold spared
- Discoid rash
- Photosensitivity of skin
- Membranes
- ulcers in mouth and nose
- serositis
- Extraglandular
- arthritis
- diffuse proliferative glomerulonephritis - kidney damage
- neuropsychiatric disorders
- Blood
- anaemia
- thrombocytopenia
- leukopenia
- ANA - sensitive but not specific
- Anti-Smith - specific but not sensitive
- Anti dsDNA
- Anti phospholipid
What are the non specific sx of SLE?
- fever
- Weight loss
- Fatigue
- lymphadenopathy
- SOB
- Raynaud’s phenomenon
What are the diagnostic criteria for SLE?
*remember SOAP BRAIN MD
- Seroritis
- Oral ulcers
- Arthritis
- Photosensitivity
- Bloods (all low)
- Renal (protein)
- ANA
- Immunologics
- Neurologic Malar rash
- Discoid rash
What Ix would you order for SLE?
- autoantibodies (ANA): Sensitive but not specific
- dsDNA & anti smith: more specific
- FBC
- Inflammatory markers
- C3 & C4: low
- C3d & C4d: high
- urineanalysis - urine protein:creatinine ratio
- renal biopsy
What drugs causes drug-induced SLE?
*remember SHIPP
- Sulfonamide
- Hydralazine
- Isoniazid
- Procanamide
- Pheytoin
Who are at risk of drug induced lupus?
- genetically predisposed individuals who are slow acetylators
What are the Cx of SLE?
- Kidneys
- lupus nephritis
- Heart
- CAD
- Pericarditis, Myocarditis, endocarditis
- Lungs
- Pleuritis
- ILD
- Infection
- Anaemia of chronic disease
- recurrent miscarriage
- venos thromboembolism - caused by aniphospholipid syndrome
- Neuropsychiatric SLE
How does neuropsychiatric SLE present?
- optic neuritis
- transverse myelitis
- psychosis
Whata are the Tx for SLE?
- First line
- NSAID
- Steroid
- Hydroxychloroquin
- Sunscream and sun avoidance
- Maintenance
- Methotrexate
- Azathioprine
- Mycophenelate Mofetil
- Severe
- Rituximab
- Belimumab
What is Belimumab?
- monoclonal antibody that targets b cell activating factor
What does antiphospholipid syndrome cause?
*rememeber CLOT
- Coagulation defect
- Livedo reticularis
- Obstetric (recurrent miscarriage)
- Thrombocytopenia
What skin disorders is commonly seen in SLE?
- Alopecia
- Livedo reticularis
- Photosensitivity
- Butterfly rash
What antibody is associated with drug induce lupus?
- anti-histone antibodies
What drug causes drug induced lupus?
- hydralazine
- procanamide
- isoniazid
- quinidine
