Systemic Lupus Erythematosus

Question 1

Define SLE

Answer 1

Chronic multi-systemic inflammatory autoimmune disorder

Question 2

Aetiology of SLE

Answer 2

Unknown

Associated drugs: procainamide, sulfasalazine isoniazid, phenytoin

Question 3

Risk factors for SLE

Answer 3

Female
Young 
Afro-Caribbean (or asian)
Drugs
15-45

Question 4

Symptoms of SLE

Answer 4

General: 
Fatigue, weight loss, fever
Oral ulcers
Alopecia
Fibromyalgia 
Photosensitivity 
Rash (malar, discoid, atypical)

MSK: arthritis, arthralgia
Heart: chest pain, discomfort
Lung: SOB, cough, 
Neuro: headache, fits, confusion
Psych: depression, psychosis
Renal: glomerulonephritis

Question 5

Describe the rashes the patient may get in SLE

Answer 5

Malar (butterfly): cheeks and bridge of nose
Discoid: red and scaly patches that heal with scarring and pigmentation
Atypical: Photosensitive, vasculitic, urticaria, purpura, bullae, livedo reticularis, Rowell’s syndrome

Question 6

Signs of SLE

Answer 6

Oral ulcers
Alopecia
Arthritis 
Rash (malar, discoid, atypical)
Raynaud's phenomenon 
HTN
Lymphadenopathy, splenomegaly

MSK: arthritis, tendonitis, myopathy
Heart: pericarditis, effusion, myocarditis
Lungs: pleural effusion, pleurites, atelectasis
Neuro: Headache, confusion, fits, stroke, CN palsy, chorea
Psych: depression, psychosis
Renal: glomerulonephritis

Question 7

Investigations for SLE

Answer 7

Antibodies (ANA, ds-DNA, anti-Smith) - positive

Urinalysis: haematuria, proteinuria, clasts

ECG: for cardiopulmonary symptoms

FBC: anaemia, thrombocytopenia, leukopenia
APTT: prolonged
U+Es: Ur and Cr elevated (renal involvement)
ESR/CRP: elevated
Complement: low C4 (moderate), low C4 + C2 (very active)

CXR: check for pleural effusion, infiltrates and cardiomegaly