Systemic Lupus Erythematosus (SLE)

Question 1

SLE:
Diagnosis criteria

Answer 1

Diagnosis
≥ 4 of the following
A RASH POINts an MD to the right diagnosis

Arthritis

Renal disease (proteinuria, cellular casts)
ANA positive (98%)
Serositis (pleurisy, pericarditis)
Haematological (haemolytic anaemia, leucopenia, lymphopenia, thrombocytopenia)

Photosensitivity
Oral ulcers
Immunological (1. ANA, 2. anti-ds DNA, 3. anti-ENA (Smith and La), ESR , anti U1RNP, low C3 C4)
Neurological (seizure, psychosis)
t
s

Malar rash
Discoid rash

*EULAR/ACR classification criteria flow diagram is more up to date for criteria (2019)

Question 2

SLE:
Symptoms and prevalence?

Answer 2

Symptoms
* Malar rash
* Photosensitive rash
* Discoid rash (20%)
* Fatigue (53% - 80%)
* Fever (>50% at onset)
* Raynaud’s phenomenon (>50% at onset)
* Arthritis/Arthralgia – typically symmetrical polyarthritis of hands and knees) (95%)
* Oral ulcers (10 – 45%)
* Pleuritis/Pericarditis (SOB and chest pain) ~15%
* Weight loss
* Alopecia/hair thinning
* HTN (suggesting nephritis - 50%)
* Lymphadenopathy
* VTE’s/ATE’s
* Abdominal pain

Question 3

SLE:
Monitoring?

Answer 3

Monitoring
-urine for glomerular RBC, ACR, casts
-early investigation of SOB, chest pain for pleurisy or pericarditis
-minimising CVD risk factors

If on hydroxychloroquine requires retinopathy reviews regularly.

Be alert to sign of infections

Malignancy screening if immunosuppressed

Question 4

SLE:
Management/Treatment?

Answer 4

Avoid sun exposure
smoking cessation
Exercise for mood benefits and fatigue reduction

Most will have hydroxychloroquine up to 5mg/kg/day (actual body weight) if tolerated.

Glucocorticoids for flares. Never monotherapy.

Early immunosuppression:
mycophenolate
methotrexate
azathioprine
Rituxumab (off label)