Systemic lupus erythematosus (SLE) Flashcards
1
Q
Describe SLE?
A
- Multisystem autoimmune disease
- Autoantibodies against autoantigens (ANA) which form immune complexes
- Incomplete removal of the complexes results in immune responses
- Causes tissue inflammation and damage
- Environmental triggers play a part (Epstein barr virus)
2
Q
Who is SLE more prevalent in?
A
- Afro-Caribbeans, Asians
- HLA B8, DR2 or DR3 positive
3
Q
Clinical features of lupus?
A
- Relapsing, remitting with variable presentation
- Often non-specific (malaise, fatigue, myalgia, fever)
- Lymphadenopathy, weight loss, alopecia, nail-fold infarcts, Raynaud’s
4
Q
What is Raynaud’s?
A
- Peripheral digit ischaemia
- Due to paroxysmal vasospasm
- Triggered by cold or emotion
5
Q
Describe the immunology of SLE?
A
- ANA (+)
- High dsDNA antibody titre
- ENA, anti-RO, anti-La, anti-Sm, anti-RNP
- Rheumatoid factor
- Anti-cardiolipin, lupus anticoagulant
6
Q
What other AI conditions can SLE be associated with?
A
- Sjogren’s
- Autoimmune thyroid disease
7
Q
Describe the diagnosis of SLE?
A
- Anti-dsDNA antibody titres
- Complement (Reduced C3, C4)
- ESR
- FBC, U&Es, LFTs, CRP
8
Q
When should SLE be considered?
A
- Multisystem disorder
- Raised ESR
- Normal CRP
9
Q
Describe drug induced lupus?
A
- >80 drugs
- Isoniazid, hydralazine, phenytoin
- Procainamide, quinidine, chlorpromazine
- Anti-TNF agents
10
Q
Describe the management of SLE?
A
- Sunblock
- Hydroxychloroquine
- Reduces disease activity and improves survival
- Topical steroids for skin flares
11
Q
Describe the maintenance of SLE?
A
- NSAIDs
- Hydroxychloroquine for joint an skin symptoms
- Steroid sparing: Azathioprine, methotrexate, mycophenolate
- Belimumab (monoclonal antibody) as add on therapy
12
Q
How can mild flares of SLE be managed?
A
- Hydroxychloroquine or
- Low-dose steroids
13
Q
How can moderate flares of SLE be managed?
A
- DMARDs or
- Mycophenolate
14
Q
How can severe flares of SLE be managed?
A
- Urgent high-dose steroids
- Mycophenolate
- Rituximab
- Cyclophosphamide
15
Q
Describe Antiphospholipid syndrome?
A
- Antiphospholipid antibodies
- Cardiolipin
- Lupus anticoagulant
- Anti- beta2 glycoprotein 1
- Signs: CLOTS
16
Q
What are the signs of Antiphospholipid syndrome?
A
- CLOTS
- Coagulation defect
- Livedo reticularis
- Obstetric (recurrent miscarriage)
- Thrombocytopenia
17
Q
Describe the diagnosis and treatment of antiphospholipid syndrome?
A
- Diagnosis
- Persistent antiphospholipid antibodies with clinical features
- Treatment
- Anticoagulation
- Seek advice in pregnancy
18
Q
Describe Systemic lupus international collaborating clinics classification
A
19
Q
Marker of Drug induced lupus?
A
Anti-histone antibodies
