Systemic lupus erythemtosus (SLE) Flashcards
What is SLE?
This is a systemic autoimmune condition that can affect almost any part of the body, in which the immune system attacks cells and tissue resulting in inflammation and tissue damage and forming immune complexes
How is most likely to be affected by SLE?
Females (9:1)
Afro-carribean, Hispanic American, Asian and Chinese ethnicity
What are some predisposing factors of SLE?
- Genetic susceptibility (HLA genes)
- Environmental factors (UV, infection)
- Immune factors
- Hormonal factors (Oestrogen)
Describe the pathogenesis of SLE?
Immune disregulation => Fast apoptosis and defective nuclear clearing
=> Macrophage phagocytosis of nuclear material
=> B & T cells produce auto-antibodies
=> Formation of immune complexes in basement membrane via nucleosome-mediated binding
=> Activation of complement system
=> Neutrophil activation
=> Basement membrane destruction and scarring
What are the 2 categories of SLE symptoms?
- Subacute cutaneous lupus erythymatosus (SCLE)
- Discoid lupus erythematosus (DLE)
What are some cutaneous presentations in SCLE?
Photosensitive malar rash
Non-Scarring alopecia
Oral ulceration
Raynaud’s phenomenon
What are some cutaneous presentations in DLE?
Discoid lupus erythematosus will cause a non-cancerous, chronic skin condition with erythematous, scalding plaques with active infalmmation, affecting the face, head and neck
How can SLE affect the joints?
Arthritis and Jaccouds arthropathy (Picture) can occur in SLE
What are some neurological symptoms of SLE?
Delirium
Psychosis
Seizure
Headache
Cranial nerve disorder
What are some haematological and cardiological symptoms of SLE?
Pleural or pericardial effusion
Acute pericarditis
Leukopenia
Haemolytic anaemia
Thrombocytopenia
What renal symptom is common in SLE?
Lupus nephritis
How can lupus nephritis be tested for?
Urinalysis showing proteinuria of >0.5g in 24 hours
Biopsy can prove nephritis
What classification criteria is used in SLE?
EULAR/ACR criteria
What tests are required in diagnosis of SLE?
Clinical examination
Immunological testing
What EULAR/ACR score provides a diagnosis of SLE?
> 10
What anti-bodies are tested for in immunological testing of SLE?
ANA - Anti-Nuclear Antibodies
Anti-dsDNA - Anti-Double-Stranded DNA antibodies
Anti-Rho antibodies
Anti-Sm antibodies
In what cases are anti-rho antibodies most commonly found?
In cases of neonatal lupus and congenital heart block
What titre is classed as a positive test for ANA in SLE?
Titres of <1:80
What are some precautions that’s should be taken in SLE patients?
Sun protection measures
Minimise steroid use
Monitor disease using SLEDAI score
What drug should be used in all cases of SLE?
Hydroxychloroquine
What drugs are used 1st line in mild SLE?
Hydroxychloroquine
Glucocorticosteroids PO
What drugs are used in refractory mild SLE?
Hydroxychloroquine
Glucocorticoids PO
Methotrexate OR Azathioprine
What drugs are used 1st line in moderate SLE?
Hydroxychloroquine
Glucocorticoids PO/IV
Methotrexate OR Azathioprine
Mycophenolate mofentil
Calcineurin inhibitors
What drugs are used in refractory moderate SLE?
Hydroxychloroquine
Glucocorticoids PO/IV
Belimumab
Mycophenolate mofentil
Calcineurin inhibitors
What drugs are used 1st line in severe SLE?
Hydroxychloroquine
Glucocorticoids PO/IV
Mycophenolate mofentil
Cyclophosphamide
What drugs are used in refractory, severe SLE?
Hydroxychloroquine
Glucocorticosteroids PO/IV
Cyclophosphamide
Rituximab
