Systemic Lupus Erythematosus - Week 17

Question 1

What is SLE?

Answer 1

Inflammatory autoimmune connective tissue Multi-system chronic disorder with antinuclear antibody presence

Question 2

Who does SLE affect?

Answer 2

Women and Asians
Young to middle aged adults
Afro Caribbean individuals

Question 3

What is the pathophysiology of SLE?

Answer 3

Anti nuclear antibodies (target own cells nucleus) causing inflammation

Question 4

What is the presentation of SLE?

Answer 4

MD SOAP BRAIN

Malar (butterfly) (photosensitive) rash, discoid rash

Serositis, oral or nasal ulcers, arthritis, photosensitivity

Blood disorders, renal involvement, ANA pos, immunologic, neurological symptoms

Additionally, weight loss, fatigue, myalgia, shortness of breath, hair loss, raynaud’s

Question 5

Investigations for SLE?

Answer 5

ANA - anti smith (v specific to SLE)
Anti ds-DNA pos
Anti phospholipid antibodies (secondary to SLE, 40% of SLE pts)

FBC (Normocytic anaemia of chronic disease)
C3 and C4decreased in active disease
Raised ESR, CRP normal unless infection
Immunoglobulins
Urine protein:creatine ratio for nephritis

Question 6

How to diagnose SLE?

Answer 6

SLICC or ACR criteria
Clinical symptoms and ANA presence

Question 7

Complications of SLE?

Answer 7

CAD
Infection
Anaemia of chronic disease (leucopenia, neutropenia, thrombocytopenia)
Pericarditis
Interstitial lung disease
Lupus nephritis
Neuropsychiatric
Recurrent miscarriage
Venous thromboembolism (antiphospholipid syndrome)

Question 8

Treatments for SLE?

Answer 8

NSAIDS, steroids (prednisolone)
HYDROXYCHLOROQUINE
Sun cream for photosensitive malar rash

Immunosuppressants (methotrexate, azathioprine)

Biologics (rituximab, belimumab)

Question 9

Prognosis for SLE?

Answer 9

Flares and continual Chronic management