Systemic lupus erythematosus (SLE)

Question 1

Define SLE

Answer 1

Multi-system inflammatory autoimmune disorder

4/11 of the diagnostic criteria of the American College of Rheumatology provides high sensitivity and specificity for the diagnosis of SLE: SOAP BRAIN MD

Serositis
Oral ulcers
Arthritis (non-erosive)
Photosensitivity

Bloods (hemolyticanemia/ leukopenia/thrombocytopenia)
Renal disease (urine casts/proteinuria)
ANA
Immunological disorder (anti-dsDNA/anti-Sm)
Neurological disease (psychosis/seizures)

Malar rash
Discoid rash

Question 2

Explain the aetiology/risk factors of SLE

Answer 2

UNKNOWN

Tissue damage may be caused by vascular immune complex deposition

Could be due to a combination of hormonal, genetic and exogenous factor

Question 3

Summarise the epidemiology of SLE

Answer 3

COMMON (1-2/1000)

More common in the YOUNG

More common in AFRO-CARIBBEAN and CHINESE

9 x more common in FEMALE

Question 4

Recognise the presenting symptoms and signs of SLE

Answer 4

General Symptoms - Fever, Fatigue, Weight loss, Lymphadenopathy, Splenomegaly

Raynaud’s phenomenon

Oral ulcers

Skin Rash - Malar Rash, Discoid Lupus, Atypical

Systemic Involvement
Musculoskeletal - arthritis, tendonitis, myopathy

Heart - pericarditis, myocarditis, arrhythmias, Libman-Sacks endocarditis

Lung - pleurisy, pleural effusion, basal atelectasis, restrictive lung defects

Neurological - headache, stroke, cranial nerve palsies, confusion, chorea

Psychiatric - depression, psychosis

Renal - glomerulonephritis

Question 5

Identify appropriate investigations for SLE

Answer 5

Bloods - FBC, U&Es, LFTs, Raised ESR, Normal CRP, Clotting, Complement

Autoantibodies - Anti-dsDNA (60%), Rheumatoid factor (30-50%), Anti-ENA, Anti-RNP, Anti-SM, Anti-Ro, Anti-La, Anti-histone, Anti-cardiolipin

Urine - haematuria, proteinuria, red cell casts

Joints - plain radiographs

Heart and Lungs - CXR, ECG, echocardiogram, CT

Kidneys - renal biopsy (if glomerulonephritis suspected)

CNS - MRI scan, lumbar puncture