Systemic Lupus Erythematous

Question 1

For Systemic lupus erythematosus (SLE):

• Define it
• Mention the 3 forms

Answer 1

Definition
• Autoimmune disease that reacts against its own tissue
• Condition may regress to an arrested state of remission or lead to death
• Inflammation can lead to severe irreversible damage to blood vessels and to kidney cells
• Most deaths in SLE are due to kidney failure
• Attacks multiple organs- heart, kidney, joints, muscles, skin

3 forms
• Blister producing form
• Neonatal form
• Chronic and sub acute form (skin)

Question 2

For Systemic lupus erythematosus (SLE):

- Describe its appearance ands symptoms (4)

Answer 2

• Appear as pigmented, erythematous patches
• Malar rash (has butterfly pattern) that occurs across the bridge of the nose and cheeks

Symptoms include:
• pain in joints 
• severe fatigue 
• bouts of fever
• Oral ulcerations are noted

Question 3

For Systemic lupus erythematosus (SLE):

- Describe its management

Answer 3

• No cure for SLE
• Pain reduction through analgesics
• Inflammation as part of the disease is treated with immuno-suppressive drugs including prednisone, hydrocortisone, etc.
• Autoimmune conditions often occur together–E.g. SLE and Rheumatoid arthritis

Question 4

For Systemic lupus erythematosus (SLE):

- Describe its risk factors (for IE and 4 other risk factors)

Answer 4

• Higher risk of infective endocarditis (IE)

Risk factors for IE
• heart disease
• chronic kidney disease
• steroid pulse therapy within 30 days
• recent invasive dental procedure within 30 days

Other risks include:
• Increased bleeding
• Infection
• Adrenal insufficiency
• Mucocutaneous ulceration

Question 5

For Systemic lupus erythematosus (SLE):

- Describe the medical risks associated with the disease, including kidney damage, and haematological disease

Answer 5

• Anaemia, leukopenia and thrombocytopenia can occur as a result of the disease process and drug therapy used to manage SL
• Patients may be at risk of infections and increased bleeding after oral trauma including subgingival instrumentation
• Lupus nephritis (kidney damage) may be present asymptomatically. May require antibiotic prophylaxis before producing bacteraemia during dental procedures - consult with GP

Question 6

For Systemic lupus erythematosus (SLE):

- How to take a history for the patient

Answer 6

• Questions should include history of disease and organs affected
• Check if patient has been diagnosed with a heart murmur
• Medications and side effects of drugs–E.g. long term use of cortisone, may be at risk of adrenal insufficiency
• Patient may not be able to respond to a stressful dental procedure
• Patient may require additional steroid to be taken before treatment- consult with GP

Question 7

For Systemic lupus erythematosus (SLE):

- The effect of heart valve damage and need for AB prophylaxis

Answer 7

• Chronic SLE
• Vegetative lesions on cardiac valves
• Autopsies after death show high prevalence of these growths- leading researchers to question the need for antibiotic prophylaxis to prevent infective endocarditis
• An echocardiogram is needed to determine involvement
Consultation with GP is necessary

Question 8

For Systemic lupus erythematosus (SLE):

- The dental management of SLE

Answer 8

• Postpone elective care during acute lupus flare-ups or high dose steroid therapy
• Use stress reducing measures
• Monitor vital signs and compare against limits of normal

• Consult with GP who will consider:

• degree of kidney and heart disease (dialysis, prophylactic antibiotics)
• blood test results (blood count, platelet count and prothrombin times) before extensive surgical or periodontal instrumentation
• potential for adrenal suppression requiring replacement therapy prior to treatment