SLE Flashcards
What is SLE?
It is a multisystem autoimmune disease that primarily affects women of child-bearing age
Who gets SLE the most?
-It is 10x more common in women and between 20-40 years
what is the aetiology of SLE?
-genetic predispositions:
HLA DR2 and HLA DR3
-hormonal factors: increased oestrogen
-environmental factors: UV light, EBV, medications: hydralazine
What is the clinical presentation of SLE?
Skin: 70% of cases
- malar rash(sparing of the nasolabial folds)
- photosensitivity
- discoid rash
- oral ulcers
- alopecia
Joints:
- arthritis and arthralgia(90% of the cases)
- non-erosive polyarthritis
- fever and fatigue
What other organ systems are affected by SLE?
- musculoskeletal-lymphadenopathy
- serositis-pleuritis and pericarditis presenting as chest pain
- kidneys: nephritis
- Heart: Libman sacks endocarditis
- Lungs- interstitial lung disease
- vascular: Raynauds phenomenon
- Neurological: psychosis, seizures
What are the different types of lupus erythematosis?
- Discoid lupus erythematosus
- Drug induced lupus erythematosus
- Subacute cutaneous lupus erythematosus
How do we diagnose SLE?
- First we suspect it if more than 2 organ systems are indicated according to the American College Of Rheumatology
- Screening with Anti-nuclear Antibody titre
- If the antibody antinuclear test is increased then we do a confirmatory test:
- Anti-dsDNA antibody testing which is positive in 70% o patients
- Anti Smith antibody testing which is highly specific
What are the 11 diagnostic criteria for SLE?
SOAP BRAIN MD
- Serositis
- orla ulcers
- arthritis
- Photosensitivity
- Blood disorders: thrombocytopenia, autoimumune hemolytic anaemia with reticulocytes, leucopenia
- Renal involvement: persistent proteinuria >0,5g per day or cellular casts
- Anti-nuclear antibodies
- Immunological phenomena: Anti-dsDNA antibodies, anti-Smith antibodies, anti-phospholipid antibodies
- Neurological disorders: psychosis and seizures
- Malar rash
- Discoid Rash
What is the treatment of SLE?
- Basic therapy: hydrochloroquine
- Induction therapy:
- mild symptoms with no organ involvement- low dose and oral glucocorticoids
- severe symptoms with no organ involvement- medium dose oral glucocorticoids
- organ involvement: IV glucorticoids - Immunosupressives- cyclophosphamide
What are the common complications of SLE?
- Lupus nephritis-50%
- accelerated atherosclerosis leading to myocardial infarction
- Pulmonary hypertension
- Antiphospholipid syndrome
- Pancytopenia
- Osteopenia/osteoporosis
what is lupus nephitis?
It is a crucial prognostic factor for SLE
- it can present as either nephrotic or nephritic syndrome
- the pathophysiology is when there are immune complex deposition in the mesangial or subendothelial cells(Anti-smith, anti-dsDNA) this then causes inflammation and damage which allows the protein or blood to flow into the system causing proteinuria or haematuria
How do we diagnose lupus nephritis?
- Do urine tests: proteinuria, haematuria, red cell casts,
2. kidney biopsy
What is the treatment of lupus nephritis?
- Prednisone
2. cyclophosphamide (immunosuppresives)
What is the most common cause of death in SLE?
- Myocardial infarction
2. end stage renal disease
