Rheumatology - Systemic Lupus Erythematosus

Question 1

Who is most commonly affected by SLE?

Answer 1

Women
Asian, African, Caribbean and Hispanic
Young to middle-aged

Question 2

Why does SLE shorten life expectancy?

Answer 2

Chronic inflammation

Question 3

What antibodies are present in SLE?

Answer 3

ANA

Auto-antibodies against proteins in the cell nucleus

Question 4

How does SLE present?

Answer 4

Photosensitive malar rash
Raynaud’s phenomenon
Fatigue
Weight loss
Arthralgia
Myalgia

Question 5

What are the investigation findings in SLE?

Answer 5

Anti-dsDNA
ANA
Anti-Sm
Antiphospholipid antibodies
Anaemia of chronic disease
Low WCC
Low platelets
Raised CRP and ESR
Proteinuria in lupus nephritis

Question 6

Outline anti-dsDNA vs ANA

Answer 6

Anti-dsDNA is highly specific but only 50% of patients will have it

ANA 85% of patients with SLE are positive for, but can be positive in healthy people with other autoimmune conditions

Question 7

Why is Anti-Sm less useful for SLE?

Answer 7

Highly specific

Poor sensitivity

Question 8

What are the complications of SLE?

Answer 8

ANTI NA
Anaemia
Nephritis
Thrombus
Inflammation, pericarditis and pleuritis

Neuropsychiatric SLE
Always ill, due to immunosuppressants

Question 9

How is SLE managed?

Answer 9

Sun cream and sun avoidance for photosensitive malar rash

First-line
Hydroxychloroquine
NSAIDS
Steroids e.g. prednisolone

Second-line
DMARDs (methotrexate, mycophenolate)
Biologics

Biological therapies
Rituximab (targets CD20 on B cells)
Belimumab