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A. MLA Map Musculoskeletal > Systemic Lupus Erythematosus (SLE) > Flashcards

Systemic Lupus Erythematosus (SLE) Flashcards

1
Q

Systemic lupus erythematous (SLE) is an autoimmune disease that can cause damage and inflammation to any tissue in the body. Typically connective tissue (blood vessels, cartilage, skin, heart, kidney, lungs) is affected. Which type of hypersensitivity is SLE?

1 - type I hypersensitivity
2 - type II hypersensitivity
3 - type III hypersensitivity
4 - type IV hypersensitivity

A

3 - type III hypersensitivity

  • antigen-immune complexes form and form clumps throughout the body
  • lead to tissue damage and inflammation
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2
Q

What is a typer III hypersensitivity?

1 - IgE mediated
2 - cell mediated hypersensitivity
3 - IgG mediated cytotoxic
4 - immune complex mediated

A

4 - immune complex mediated
- antigen-immune complexes form and form clumps throughout the body leading to tissue damage and inflammation

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3
Q

Although the exact cause of Systemic lupus erythematosus (SLE) is unknown, it is though that susceptible genes and environmental factors may be triggers that initiate SLE. If a cell becomes damaged and undergoes apoptosis the contents are released. Typically what is important in SLE that is released from these cells?

1 - DNA
2 - histones
3 - nuclear proteins
4 - all of the above

A

4 - all of the above
- as these are all from the nucleus of the cell they are called nuclear antigens
- patients with SLE are less able to clear the nuclear antigens so they float around in the circulation

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4
Q

In Systemic lupus erythematous (SLE) cells undergoing apoptosis release their contents, specifically those contents from the nucleus are referred to as nuclear antigens. How can the release of nuclear antigens then cause a type III hypersensitivity?

1 - immune cells recognise the antigens as foreign invades
2 - immune cells target all self cells randomly
3 - nuclear antigens initiate the release of cytokines
4 - all of the above

A

1 - immune cells recognise the antigens as foreign invades
- triggered by susceptible genes and/or environmental factors

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5
Q

In Systemic lupus erythematous (SLE) cells undergoing apoptosis release their contents, specifically those contents from the nucleus are referred to as nuclear antigens, which immune cells recognise as foreign antigens. Which cell is then able to bind to these antigens and then produce anti-nuclear antibodies (ANA) against these nuclear antigens?

1 - B cells
2 - NK cells
3 - T cells
4 - Monocytes

A

1 - B cells
- MHC-II bind with antigens
- they produce ANA antibodies

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6
Q

Are antinuclear antibodies (ANA) present in all cases of Systemic lupus erythematous (SLE)?

A
  • yes

Targets:
- DNA
- histones
- nuclear proteins

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7
Q

Once anti-nuclear antibodies (ANA) bind with the nuclear antigens in the circulation, what are they called?

1 - antibody complex
2 - immune mediated complexes
3 - antigen-antibody complexes
4 - B cell complexes

A

3 - antigen-antibody complexes
- these complexes can get stuck in blood vessels or any tissues
- this is a type III hypersensitivity

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8
Q

Antigen-antibody complexes can travel around the body and get stuck in blood vessels or any tissues. Once lodged in some tissues, what do these complexes cause?

1 - local inflammatory reaction
2 - complement pathway activation
3 - cells become damaged and undergo apoptosis
4 - all of the above

A

4 - all of the above

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9
Q

Which of the following have been identified as triggers for Systemic lupus erythematous (SLE)?

1 - smoking
2 - UV radiation
3 - genetic susceptibility
4 - microorganisms (virus, bacteria)
5 - medications
6 - sex hormones (estrogen specifically)
7 - all of the above

A

7 - all of the above

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10
Q

Systemic lupus erythematous (SLE) is an autoimmune disease that can affect any tissue in the body. What is the prevalence of SLE?

1 - 1-10 / 100,000
2 - 10-20 / 100,000
3 - 6-31 / 100,000
4 - 30-60 / 100,000

A

3 - 6-31 / 100,000

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11
Q

Systemic lupus erythematous (SLE) is an autoimmune disease that can affect any tissue in the body and any ethnicity. Which of the following have a higher risk of developing SLE?

1 - europeans
2 - asians
3 - native americans
4 - african-caribbean

A

4 - african-caribbean

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12
Q

Systemic lupus erythematosus (SLE) which is a form of connective tissue disease, is an autoimmune disease that is a type III hypersensitivity. Antigen-immune complexes form and form clumps throughout the body leading to tissue damage and inflammation. What age does this generally occur?

1 - 15-25 y/o
2 - 15-30 y/o
3 - 15-40 y/o
4 - >40 y/o

A

3 - 15-40 y/o
- the mean age is 49

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13
Q

Systemic lupus erythematous (SLE) is an autoimmune disease that can affect any tissue in the body. Does SLE affect men or women more?

A
  • women
  • women of child bearing age
  • estrogen is strongly linked with this
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14
Q

In addition to creating anti-nuclear antibodies (ANA) against nuclear contents. In systemic lupus erythematous (SLE) patients also develop antibodies against other cells and molecules, such as what?

1 - WBCs
2 - phospholipids
3 - RBCs
4 - all of the above

A

4 - all of the above
- these are type II hypersensitivity reactions
-type II = IgG mediated cytotoxicity or complement activation by IgG antibodies binding to these cells

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15
Q

Which HLA associations have been linked with SLE?

1 - B8
2 - DR2 and DR3
3 - DRB1*0301 and *1501
4 - all of the above

A

4 - all of the above

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16
Q

Which of the following is NOT part of the classic presentation of Systemic lupus erythematous (SLE)?

1 - fever with fatigue
2 - rash
3 - palpitations
4 - joint pain
5 - weight loss

A

3 - palpitations
- all the other symptoms in a women of child bearing age is the classical presentation

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17
Q

Systemic lupus erythematosus (SLE) is an autoimmune disease that can cause damage and inflammation to any tissue in the body, but generally connective tissue (blood vessels, cartilage, skin, heart, kidney, lungs) and is a type III hypersensitivity. What other common syndromes can often be caused by SLE due to antibodies?

1 - kallman syndrome
2 - antiphospholipid syndrome
3 - vasculitis
4 - metabolic syndrome

A

2 - antiphospholipid syndrome
- antibodies target phospholipids and proteins in cell membranes
- classed as a type II hypersensitivity

18
Q

Anti-nuclear antibodies (ANA) can be elevated in systemic lupus erythematosus (SLE). When measuring ANA, does it have a high sensitivity and specificity for SLE?

A
  • no
  • ANA can be raised in other immune disorder
  • HIGH sensitivity (confirm a disease)
  • LOW specificity (rule out the disease)
19
Q

Systemic lupus erythematosus (SLE) is an autoimmune disease that can cause damage and inflammation to any tissue in the body, but generally connective tissue (blood vessels, cartilage, skin, heart, kidney, lungs) and is a type III hypersensitivity. What are the 2 SLE specific antibodies that are commonly present other than anti-nuclear antibodies?

1 - ANA and anti-Smith
2 - ANA and dsDNA
3 - dsDNA and anti-Smith
4 - dsDNA and anti-CCP

A

3 - dsDNA and anti-Smith (nuclear protein)

  • dsDNA is most specific
20
Q

Anti-double stranded DNA antibodies (dsDNA) are used to try and diagnose Systemic lupus erythematosus (SLE). Is ANA or dsDNA more specific to SLE?

A
  • dsDNA is better
  • ANA can be raised in a number of autoimmune disorders
21
Q

Are anti-smith antibodies or ANA more specific to systemic lupus erythematosus (SLE)?

A

anti-smith antibodies
- ANA can be raised in a number of autoimmune disorders

22
Q

A diagnostic test to try and diagnose systemic lupus erythematosus (SLE) is C3 and C4 of the complement pathway which are active in SLE. In the test, would we expect to see raised or decreased levels of C3 and C4 in active SLE?

A
  • reduced
  • C3 and C4 is being used to promote an inflammatory reaction so levels appear low
  • in remission C3 and C4 levels will return to normal
23
Q

Systemic lupus erythematous (SLE) is an autoimmune disease that can cause damage and inflammation to any tissue in the body, but generally connective tissue (blood vessels, cartilage, skin, heart, kidney, lungs) and is a type III hypersensitivity. What 2 inflammatory markers are commonly elevated in SLE?

1 - ESR and IL-6
2 - ESR and CRP
3 - creatine kinase and ESR
4 - creatine kinase and CRP

A

2 - ESR and CRP
- THINK SLE if a patient high high ESR but normal CRP

  • ESR is low as the proteins and inflammatory markers stick to RBCs and mean they fall faster and therefore lower ESR
24
Q

Although there are lots of tests that can be performed in an attempt to diagnose SLE, typically which 3 of the following are most specific to systemic lupus erythematous (SLE)?

1 - ESR
2 - low C3 and C4
3 - CRP
4 - anti smith
5 - anti dsDNA
6 - ANA

A

1 - ESR
2 - low C3 and C4
5 - anti dsDNA

25
Q

Systemic lupus erythematous (SLE) is an autoimmune disease that can cause damage and inflammation to any tissue in the body, but generally connective tissue (blood vessels, cartilage, skin, heart, kidney, lungs) and is a type III hypersensitivity. Why would we want to do a FBC in SLE?

1 - damage to tissues could increase RBC number
2 - systemic inflammation can reduce WBC number
3 - anaemia of chronic disease
4 - bone marrow suppression

A

3 - anaemia of chronic disease

Can be caused by:
- damaged kidney producing less erythropoietin
- auto-antibodies targeting RBCs
- blood loss in GIT
- steroid effects

26
Q

Diagnosing Systemic lupus erythematous (SLE) can be difficult. Typically the 11 point criteria set out in the Systemic Lupus International Collaborating Clinics Classification is used. I addition to a positive ANA, how many of the 11 criteria are required?

1 - >2
2 - >4
3 - >7
4 - >10

A

2 - >4
- also need at least 1 of the laboratory criteria

27
Q

SLE is a multiple system disease, but which of the following is most commonly affected?

1 - Skin
2 - Joints
3 - CVS
4 - Renal
5 - CNS
6 - GIT

A

1 - Skin

28
Q

Which of the following is NOT common in patients with Systemic lupus erythematous (SLE)?

1 - malar/butterfly rash on the face (after sun exposure)
2 - discoid rash (plaque like that can scar)
3 - non-scarring alopecia/ photosensitivity (lasts days)
4 - dermatitis herpetiformis

A

4 - dermatitis herpetiformis
- can occur in coeliac disease

  • the others are the 1st 3 of the Systemic Lupus International Collaborating Clinics Classification
29
Q

The skin is the most affected organ in the body in SLE. What is the term given to butterfly rash on the face that patients can present with, as per the image below?

1 - Livedo Reticularis
2 - Lupus Profundus
3 - Acute cutaneous lupus erythematosus (CCLE)
4 - Discoid Lupus (DLE)

A

3 - Acute cutaneous lupus erythematosus (CCLE)

30
Q

The skin is the most affected organ in the body in SLE. What is the term given to a net like appearance, mainly affected the legs, as per the image below?

1 - Livedo Reticularis
2 - Lupus Profundus
3 - Acute cutaneous lupus erythematosus (ACLE)
4 - Discoid Lupus (DLE)

A

1 - Livedo Reticularis

31
Q

The skin is the most affected organ in the body in SLE. What is the term given to a appearance, as per the image below?

1 - Livedo Reticularis
2 - Lupus Profundus
3 - Acute cutaneous lupus erythematosus (ACLE)
4 - Discoid Lupus (DLE)

A

4 - Discoid Lupus (DLE)

32
Q

Which of the following is NOT common in patients with Systemic lupus erythematous (SLE)?

1 - oral/nasal on mucus membranes
2 - lymphadenopathy
3 - serositis (inflammation of serosa of organs, i.e. pericarditis and pleuritis)
4 - synovitis (inflammation of >2 joints)
5 - urinalysis (raised protein or red cell casts)

A

2 - lymphadenopathy

  • the others are the 4-7 of the Systemic Lupus International Collaborating Clinics Classification
33
Q

Joints can be affected in SLE, is this typically symmetrical or asymmetrical?

A
  • symmetrical

Typically:
- affects hands, BUT non-erosive
- hands, hip and knee are common

34
Q

Joints can be affected in SLE. Is the axial or appendicular skeleton affected in SLE?

A
  • only appendicular skeleton
35
Q

Which of the following is NOT common in patients with Systemic lupus erythematous (SLE)?

1 - hypoalbuminemia
2 - neurological disorders (seizures and psychosis)
3 - haematological anaemia
4 - leucopenia
5 - thrombocytopenia

A

1 - hypoalbuminemia

  • the others are the 8-10 of the Systemic Lupus International Collaborating Clinics Classification
36
Q

Are anti-smith antibodies or ANA more specific to systemic lupus erythematous (SLE)?

A

anti-smith antibodies

37
Q

Which of the following can help manage SLE in patients?

1 - Cessation of smoking
2 - Sun protection
3 - Diet and Exercise
4 - all of the above

A

4 - all of the above

38
Q

When managing a patient with systemic lupus erythematous (SLE) we should try to identify triggers and reduce their risk such as sun exposure. Which class of medication is NOT typically used in the maintenance of SLE?

1 - NSAIDs
2 - immunosupressants
3 - glucocorticoids
4 - antimalarials

A

3 - glucocorticoids
- NSAIDs only if no renal disease
- antimalarials = hydroxychloroquine is the most commonly used medication

  • hydroxychloroquine = inhibits TLR and reduces immunomodulators effects
39
Q

When managing a patient with systemic lupus erythematous (SLE) we should try to identify triggers and reduce their risk such as sun exposure. Which 2 of the following of medications is typically used in a mild flare up of SLE?

1 - NSAIDs
2 - Azathioprine, Methotrexate or Mycophenolate
3 - prednisolone
4 - hydroxychloroquine (antimalarials)

A

3 - prednisolone
- given at a low dose

4 - hydroxychloroquine
- typically used for mild forms of SLE

40
Q

When managing a patient with systemic lupus erythematous (SLE) we should try to identify triggers and reduce their risk such as sun exposure. If prednisolone and hydroxychloroquine have failed immunosuppressive therapy can be used. Which of the following is NOT commonly used in SLE?

1 - Methotrexate
2 - Azathioprine
3 - Cyclophosphamide
4 - Mycophenolate

A

1 - Methotrexate

Biological Agents can be tried if all else fails:
- Belimumab
- Rituximab

41
Q

All of the following are complications of SLE, EXCEPT which one?

1 - Skin scarring and alopecia
2 - Liver cirrhosis
3 - Psychosis , Dementia
4 - Thrombotic episodes, early Stroke
5 - Accelerated atherosclerosis, CAD
6 - Pulmonary Arterial Hypertension (PAH)
7 - Pseudo intestinal obstruction

A

2 - Liver cirrhosis

A. MLA Map Musculoskeletal (4 decks)

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