Systemic Lupus Erythematosus

Question 1

What is systemic lupus erythematosus?

Answer 1

Inflammatory autoimmune connective tissue disease

Question 2

What is this a presentation of?

Young Asian woman, varying non-specific symptoms, photosensitive malar rash.

Answer 2

Systemic lupus erythematosus

Question 3

What are the results of the following investigations in systemic lupus erythematosus?

1. FBC
2. C3 and C4
3. CRP and ESR
4. Ig

Answer 3

1. Normocytic anaemia of chronic disease
2. Decreased in active disease
3. Raised with active inflammation
4. Raised due to B-cell activation

Question 4

How is lupus nephritis investigated in systemic lupus erythematosus?

Answer 4

1. Urinalysis and urine protein:creatinine ratio

2. Renal biopsy

Question 5

Which antibodies are found in systemic lupus erythematosus?

Answer 5

1. Anti-nuclear (85%) - initial step for diagnosis
2. Anti-double stranded DNA (70%, specific) - levels vary with disease activity
3. Anti-extractable nuclear antigen - anti-Smith
4. Antiphospholipid (40%)

Question 6

How is systemic lupus erythematosus diagnosed?

Answer 6

SLICC criteria/ACR criteria - confirm presence of ANA and establishing certain number of clinical features.

Question 7

What is the leading cause of death as a complication of systemic lupus erythematosus?

Answer 7

Cardiovascular disease

Question 8

What are the main complications of systemic lupus erythematosus?

Answer 8

1. CVD, pericarditis
2. Infection
3. Anaemia
4. Pleuritis, interstitial lung disease
5. Lupus nephritis
6. Neuropsychiatric issues
7. Recurrent miscarriage
8. VTE

Question 9

What is the treatment for systemic lupus erythematosus?

Answer 9

1. NSAIDs, prednisolone, hydroxychloroquine
2. Methotrexate, other immunosuppressants
3. Biological therapies in severe disease