Systemic Lupus Erythematosus Flashcards

1
Q

what is SLE?

A

multi-system auto-immune disease manifesting differently in different patients

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2
Q

what is the epidemiology of SLE?

A
  • female
  • afro-caribbean
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3
Q

what is the classical presentation of SLE?

A
  • systemic upset - fever/myalgia/fatigue/weight loss
  • joint and/or skin involvement
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4
Q

what are the triggers for a flare-up of SLE?

A
  • oestrogen-containing contraception
  • overexposure to sunlight
  • infections
  • stress
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5
Q

what are the dermatological presentations of SLE?

A
  • photosensitivity - malar rash
  • discoid rash (round, raised plaques)
  • mouth/nose/genital ulcers
  • hair loss
  • cutaneous vasculitis - splinter haemorrhages/purpura
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6
Q

what is a malar rash?

A

symmetrical, butterfly shaped rash across both cheeks

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7
Q

what is discoid lupus?

A

discoid rash alone with no other features of SLE

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8
Q

what is the typical joint manifestation in SLE?

A
  • arthritis (non-erosive) or arthralgia
  • polyarthritis
  • symmetrical or asymmetrical
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9
Q

what is the cardiovascular presentation of SLE?

A
  • raynauds phenomenon
  • pericarditis
  • myocarditis
  • increased cardiovascular disease risk
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10
Q

what is the respiratory presentation of SLE?

A
  • pleurisy and pleural effusions
  • pneuomonitis - acute can mimic pneumonia and chronic causes pulmonary fibrosis
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11
Q

what is the renal presentation of SLE?

A

lupus nephritis
* can be asymptomatic
* monitored regularly - BP and urinalysis

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12
Q

what is the neurological presentation of SLE?

A
  • seizures
  • migraines
  • peripheral neuropathies
  • psychiatric symptoms - psychosis, depression, anxiety

cerebral lupus = unremitting headache + psychosis

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13
Q

what is the haematological presentation of SLE?

A
  • anaemia of chronic disease
  • lymphopenia
  • autoimmune haemolytic anaemia
  • thrombocytopenia
  • leucopoenia
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14
Q

what is the GI presentations of SLE?

A
  • peritonitis (aseptic)
  • hepatosplenopmegaly
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15
Q

what conditions can arise secondary to SLE?

A
  • secondary sjogren’s syndrome
  • secondary anti-phospholipid syndrome
  • mixed connective tissue disease
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16
Q

what is the typical presentation for drug-induced lupus (DIL)?

A
  • triggered by chronic use of certain drugs for over one month
  • systemic upsest
  • arthritis (non-erosive) or arthralgia
  • serositis - pleurisy or pericarditis
17
Q

what drugs can cause drug-induced lupus?

A
  • sulfadiazine
  • hydralazine
  • procainamide
  • isoniazid
  • methyldopa
  • quinidine
  • minocycline
  • chlorpromazine
18
Q

what investigations should be carried out in drug-induced lupus?

A
  • autoantibodies = +ve ANA but -ve anti-dsDNA and anti-sm
  • +ve anti-histone
  • raised inflammatory markers
19
Q

what investigations are carried out in suspected SLE?

A
  • FBC and clotting screen
  • U&Es and urinalysis
  • ESR and CRP
  • ANA, anti-dsDNA and anti-sm
  • low complement (C3 and C4)
20
Q

what tests are carried out to determine renal involvement in SLE?

A
  • urinalysis
  • renal ultrasound
  • renal biopsy = diagnostic
21
Q

what investigations is performed in suspected cerebral lupus?

A

brain MRI

22
Q

what autoantibodies are seen in SLE?

A
  • antinuclear antibodies (ANA) = sensitive not specific
  • anti-dsDNA
  • anti-sm
23
Q

what mneomonic can be used to help diagnose SLE?

A

A RASH POINTs MD
Arthritis/arthralgia
Renal disease
ANA positive
Serositis (pericarditis/pleurisy/pleural effusion)
Haematological (haemolysis/low WCC/platelets/lymphocytes)
Photosensitivity rash
Oral ulcers
Immunological tests +ve
Neuropsychiatric
Malar rash
Discoid rash

present of >/= 4

24
Q

what is the treatment for mild SLE?

A

NSAIDs + hydroxychloroquine

25
Q

what is the medical management of a flare of SLE?

A

short courses of corticosteroids

26
Q

what is the management of a severe flare of SLE?

A

cyclophosphamide (immunosuppressant) + corticosteroids

27
Q

what is the management of lupus glomerulonephritis?

A

high dose steroids + immunosuppression

28
Q

what is the management of cerebral lupus?

A

high dose steroids + immunosuppression (cyclophosphamide/azathioprine)