Systemic Lupus Erythematosus (SLE)

Question 1

what is SLE?

Answer 1

• This is an inflammatory autoimmune connective tissue disease.
• Systemic because it affects multiple organs and systems whilst the erythematosus part refers to the malar rash seen in SLE.

Question 2

who is SLE common in?

Answer 2

• Common in women and Asians and usually in young to middle aged adults.

Question 3

brief pathophysiology of SLE?

Answer 3

• Characterised by antinuclear antibodies.
• There are antibodies to proteins within the persons own cell nucleus.
• This causes the immune system to target these proteins and when activated, the immune system generates an inflammatory response.
• Inflammation in the body then leads to the symptoms of the condition.

Question 4

how do SLE patients present?

Answer 4

1) Fatigue
2) Weight loss
3) Arthralgia
4) Myalgia
5) Fever
6) Malar rash
7) Lymphadenopathy and splenomegaly
8) SOB
9) Pleuritic chest pain
10) Mouth ulcers
11) Hair loss
12) Raynaud’s phenomenon

Question 5

what Ix would you consider if you had a ?SLE

Answer 5

1) ANA
2) FBC
3) C3 and C4 (decreased in active disease)
4) CRP and ESR (raised with active inflammation)
5) Immunoglobulin
6) Urinalysis and urine protein:creatinine ratio for proteinuria in lupus nephritis.
7) Renal biopsy for lupus nephritis.

Question 6

what are the complications of SLE?

think CVS, resp, haem, kidneys, fertility, neuro ?

Answer 6

1) CVD – chronic inflammation  HTN and CAD
2) Infection
3) Haem - Anaemia of chronic disease  affecting bone marrow leading to chronic normocytic anaemia, leucopenia, neutropenia and thrombocytopaenia.
4) Pericarditis
5) Pleuritis aka pleurisy (sharp pain on inspiration)
6) ILD (PF)
7) Lupus nephritis  end stage renal failure (therefore take a renal biopsy and protein:creatinine ratio)
8) Neuropsychiatric SLE  optic neuritis (optic nerve inflammation), transverse myelitis (inflammation of spinal cord) or psychosis.
9) Recurrent miscarriage
10) VTE

Question 7

mx of SLE

Answer 7

1) NSAIDs
2) Steroids
3) HCQ (first line for mild SLE)
4) Sun cream for malar rash.
5) Methotrexate
6) Mycophenolate mofetil
7) Azathioprine
8) Tacrolimus
9) Leflunomide
10) Ciclosporin
11) Biological – rituximab (anti CD20 on B cells)
12) Biological – belimumab (anti-B cells)