Seminar G - SLE Flashcards Preview

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Flashcards in Seminar G - SLE Deck (27):
1

Definition

A multi-system inflammatory disease with a wide range of clinical manifestations.

2

Pathophysiology

Excess production of pathogenic autoantibodies
→Anti-nuclear anti-body (ANA)

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Epi

1 in 4000
Female: Male 9/13:1

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Genetic Link

First degree relative family members being 50 times more likely to develop the disease than the background population.
HLA-DR2 and DR3 (increased susceptibility)

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Environmental Link

Sex hormones are known to influence disease activity:
1. Patients can experiences an exacerbation of symptoms pre-menstrually
2. OCP can cause a flare
3. Pregnancy can cause a flare (can be a threat to baby and mother)
4. UV light → causes increased rashes and systemic flare
5. Hydralazine – can causes a lupus-like illness.

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Autoantibodies

Anti-dsDNA
Anti-Ro
Anti-LA

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Antibodies cause

Complement mediated lysis
Enhanced phagocytosis (by mononuclear cells)
Vasculitis → via binding of immunoglobulins to intracellular proteins and nucleic acids
Glomerulonephritis

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Rare presentation

SLE may cause a symmetrical small-joint polyarthropathy similar to that seen in RA
Note: it is non-deforming (i.e. correctible) Jaccoud’s arthropathy

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5 year survival

90%

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15 year survival

85%

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Mortality from

Renal disease
Cardiovascular disease
Accelerated Atherosclerosis

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General Features

Fever
Malaise
Weight loss

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MSK

Arthralgia in 90%
Jaccoud’s arthropathy
Myalgia/myositis

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Skin

Butterfly rash in 30%
Other rashes
Photosensitivity
Alopecia
Mucosal ulceration
Raynaud’s phenomenon

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Cardiovascular

Pericarditis
Myocarditis
Endocarditis (libman-Sachs)
Thomboembolism (arterial and venous)
Accelerated atherosclerosis

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Pulmonary

Pleurisy (in up to 60%)
Pleural effusions
Interstial fibrosis

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Renal

Proteinuria/nephrotic Syndrome
Haematuria
Glomerulonephritis (any subtype)

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Haematological

Anaemia
Leukopenia (particularly lymphopenia)
Thrombocytopenia

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Neurological

Headaches
Seizures
Psychosis
Mononeuritis multiplex

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GI

Mesenteric vasculitis
Autoimmune hepatitis

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Immunological

Immune paresis

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Reproductive

Recurrent miscarriages
Premenstrual flares
Flares during pregnancy
Neonatal lupus with congenital heart block

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Treatment → Avoid

Sun exposure
High factor sun protection

24

Treatment → NSAIDs for

Joint pains
Caution in pains with renal disease

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Treatment → Hydroxychloroquine

Alleviate symptoms in the medium term, but does nothing to treat the more serious manifestations of the disease such as neurological

26

Treatment → Glucocorticoids

Under specialist supervision

27

Treatment → Immunosuppressants

Azathioprine
Cyclophoshamide
Methotrexate

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