Systemic lupus erythematosus (SLE)

Question 1

What kind of condition is SLE?

Answer 1

Systemic inflammatory autoimmune connective tissue disease

Question 2

What does the ‘erythematosus’ in the name refer to?

Answer 2

Typical red malar rash that occurs across the face

Question 3

Which people is SLE more common in, and when does it most commonly present?

Answer 3

Women and Asians and usually presents in young to middle aged adults

Question 4

1) What is the commonest disease course in SLE?
2) Why do patients with SLE often have a shortened life expectancy?
3) What are the 2 leading causes of death in patients with SLE?

Answer 4

1) Relapsing-remitting
2) Chronic inflammation
3) Infection and CVD

Question 5

1) SLE is characterised by what type of antibodies?
2) These antibodies are targeted against what, leading to what?

Answer 5

1) Anti-nuclear antibodies (ANA)
2) Antibodies to proteins within the person’s own cell nucleus, leading to inflammation

Question 6

SLE presents with non-specific symptoms - name 4 of these

Answer 6

• Fatigue
• Weight loss
• Arthralgia and non-erosive arthritis
• Myalgia
• Fever
• Photosensitive malar rash. This is a “butterfly” shaped rash across the nose and cheek bones that gets worse with sunlight.
• Lymphadenopathy and splenomegaly
• Shortness of breath
• Pleuritic chest pain
• Mouth ulcers
• Hair loss
• Raynaud’s phenomenon

Question 7

1) What is the initial step in testing for SLE in someone with symptoms of the condition?
2) What is the negative aspect of this test?
3) What antibody is specific to SLE?

Answer 7

1) ANA blood test
2) It can be raised in other autoimmune conditions i.e. autoimmune hepatitis
3) Anti-double stranded DNA (anti-dsDNA)

Question 8

Complications
1) What cardiovascular complications does SLE lead to?
2) Anaemia of chronic disease is common in SLE, what type of anaemia can it cause?
3) What other blood cells can be low in SLE?
4) Name 2 other complications of SLE that are linked to the cardiac/respiratory systems
5) Name 3 other complications of SLE

Answer 8

1) Hypertension and CAD
2) Chronic normocytic anaemia (warm AHA)
3) Leucopenia, thrombocytopenia, neutropenia
4) Pericarditis, interstitial lung disease, pleuritis
5) Lupus nephritis, neuropsychiatric SLE (psychosis, optic neuritis, transverse myelitis), VTE which is associated with antiphospholipid syndrome, which is associated with SLE, recurrent miscarriage

Question 9

1) Name 2 1st line treatment for SLE
2) Name 2 other immunosuppressants that may be used in more severe SLE
3) If the above treatments don’t work, biological therapies such as rituximab can be used; how does this drug work?
4) How does belimumab work?

Answer 9

1) NSAIDs, hydroxychloroquine (1st line for mild) and prednisolone
2) Methotrexate, mycophenolate mofetil, azathioprine, tacrolimus, leflunomide, ciclosporin
3) Monoclonal antibody for the CD20 protein on the surface of B cells
4) Monoclonal antibody that targets B-cell activating factor

Question 10

Low levels of which type of complement is associated with the development of SLE?

Answer 10

C4