RA and SLE

Question 1

What is Ankylosing Spondylititis?

Answer 1

Chronic spinal inflammation that can result in spinal fusion and deformity
Site of inflammation includes the enthesis
No autoantibodies (‘seronegative’)

Question 2

What are the main features of SLE?

Answer 2

Chronic tissue inflammation in the presence of antibodies directed against self antigens
Multi-site inflammation but particularly the joints, skin and kidney
Associated with autoantibodies

Question 3

What are some examples of connective tissue diseases?

Answer 3

Systemic lupus erythematosus
Sjogren’s syndrome
Autoimmune Inflammatory muscle disease
Systemic sclerosis (scleroderma)
Overlap syndromes

Question 4

What are the key autoantibodies in SLE?

Answer 4

Antinuclear antibodies
Anti-double stranded DNA antibodies
Anti-phospholipid antibodies

Question 5

What is Arthralgia?

Answer 5

Pain in joints
Tenderness but not obvious inflammation
Common in connective tissue disorders

Question 6

What are the main features of autoantibodies?

Answer 6

Characteristic
May aid diagnosis
Correlate with disease activity
May be directly pathogenic

Question 7

What is Raynaud’s phenomenon?

Answer 7

Intermittent vasospasm of digits on exposure to cold
Typical colour changes – white to blue to red
Vasospasm leads to blanching of digit
Cyanosis as static venous blood deoxygenates
Reactive hyperaemia

Question 8

What are the main manifestations of Lupus?

Answer 8

Malar rash – erythema that spares the nasolabial fold
Photosensitive rash
Mouth ulcers
Hair loss
Raynaud’s phenomenon
Arthralgia and sometimes arthritis
Serositis (pericarditis, pleuritis, less commonly peritonitis)
Renal disease – glomerulonephritis (‘lupus nephritis’)
Cerebral disease – ‘cerebral lupus’ e.g. psychosis

Question 9

Who typically gets Lupus?

Answer 9

female aged between 15 – 45 years

Question 10

Which rheumatoid conditions are seronegative?

Answer 10

OA
Reactive arthritis
Gout
Ankylosing Spondylitis

Question 11

What are the key investigations for Lupus?

Answer 11

ESR
CRP is usually normal
Autoantibodies
Antiphospholipid antibodies

Question 12

What haematological investigations are done in Lupus?

Answer 12

Haemolytic anaemia, Lymphopenia, Thrombocytopenia

Question 13

What renal in

investigations are done in Lupus?

Answer 13

very important to measure urine protein (most commonly urine protein:creatinine ratio [uPCR])
look at albumin

Question 14

How can we measure disease activity in SLE?

Answer 14

Immune complexes

Unwell lupus patient has LOW complement C3 and C4 levels and HIGH levels of anti-ds-DNA antibodies

Question 15

What is the aim of SLE treatment?

Answer 15

Treatment in SLE aims at remission or low disease activity and prevention of flares

Question 16

What should patients with SLE be assessed for?

Answer 16

antiphospholipid antibody status

infectious and cardiovascular diseases risk profile

Question 17

How is SLE treated?

Answer 17

Hydroxychloroquine is recommended in all patients with lupus

Maintenance treatment glucocorticoids should be minimised and, when possible, withdrawn.

Appropriate initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can expedite the tapering/discontinuation of glucocorticoids

In persistently active or severe disease we use cyclophosphamide and B cell targeted therapies (rituximab and belimumab)

Question 18

What needs to be considered re management in Lupus patients?

Answer 18

Pregnancy planning

Question 19

What is Sjorgren’s syndrom?

Answer 19

Autoimmune exocrinopathy

lymphocytic infiltration of especially exocrine glands and sometimes of other organs (extra-glandular involvement)

Question 20

What does exocrine gland pathology result in?

Answer 20

Dry eyes (xerophthalmia)
Dry mouth (xerostomia)
Parotid gland enlarg

Question 21

What is inflammatory muscle disease?

Answer 21

Proximal muscle weakness due to autoimmune-mediated inflammation either with (dermatomyositis) or without (polymyositis) a rash

Question 22

What is systemic scelrosis?

Answer 22

Thickened skin with Raynaud’s phenomenon
Dermal fibrosis, cutaneous calcinosis and telangiectasia
Skin changes may be limited or diffuse

Question 23

What is overlap syndrome?

Answer 23

When features of more than 1 connective tissue disorder are present e.g. SLE and inflammatory muscle disease we can use the term overlap syndrome