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Long Case - Rheumatology > SLE > Flashcards

Flashcards in SLE Deck (7)
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1

What is SLE
Common associations

A multisystem, autoimmune disease characterised by B cell secretion of autoantibodies to a variety of autoantigens which form immune complexes that deposit in a range of sites eg Kidneys
Typically affects females of child bearing age and ethnic peoples

associations:
- Sjogren's syndrome
- AI thyroid disease
- Antiphospholipid syndrome

2

Diagnostic factors?

DRAMA SIPHON

D - discoid rash
R - renal disorders
A - arthritis
M - malar rash
A - ANA +ve

S - serositis (pleuritis + pericarditis)
I - immunological (AB studies)
P - photosensitivity
H - haematological (haem anaemia, leukpoenia, throm)
O - oral ulcers
N - neurological (seizures or psychosis)

3

Symptoms and Signs of SLE

Symptoms:
most present predominantly with rash (of which there are several), arthritis and hameatological/immunological abnormalities

other Sx: systems inquiry essentially
- general = malaise, weight loss, fever
- MSK = arthralgia/arthritis
- Derm = rash, alopecia, oral and nasal ulcers
- Neuro = delirium, dementia, convulsions, LOV, stroke, headache, depression, anxiety
- renal = haematuria, oedema, high BP
- Resp = dyspnea and CP
- Cardio = pericarditis, myocarditis, murmurs, angina
- Haem = lymphadenopathy, anaemia, thrombophlebitis
- GI = nausea, vomiting, pseudoobstruction
- Antiphospholipid = recurrent miscarriage, DVT/PE
- Sjogrens symptoms = dry eyes, mouth, enlarged parotid

4

Examination for SLE

General: cushingoid, weight loss, mental state
Skin: discoid and malar rash, photosensitivity
Hands: vasculitis, rash, raynauds, arthropathy
arms: livedo retiularis, purpura, proximal myopathy
head: alopecia, eyes for scleritis, mouth for ulcers, CN lesions
Chest: murmur, rub, P effusion, Pulmonary fibrosis, collapse
abdo: heptosplenomegaly
legs: rash, prox myopathy, small j synovitis, cerebellar ataxia
Other: BP, temp, urinanalysis

5

Investigations for SLE

Haematological:
FBC: normocytic/chromic anaemia of chronic disease
: haemolytic anaema = high retics and bili
ESR elevated with normal CRP
Leukopenia and thrombocytopenia
Prolonged APTT that is not corrected with addition of normal plasma

Immunological:
ANA = sensitive not specific
Anti-dsDNA, Anti-SM - specific (70%)
Low C3 and C4 as being consumed in active disease

Other:
renal biopsy (minimal change, membraneous, diffuses, FSGN)

6

Management of SLE:

Acute Flares:
-Prednisolone
-IV cyclophosphamide - for life threatening flare

Maintenance:
- NSAIDs + hydroxychloroquine for joint and skin
- Steroids for CNS, Lungs, heat, haem
- Methotrexate, mycophenolate/azathioprine for steroid sparing
- warfarin for hypercoagulability - if prev DVT/PE

Lupus Nephritis:
- Steroids + cyclophosphamide
- Mycophenolate and rituximab for GN
- ACE/ARB for BP

Cutaneous Sx:
- Topical steroids
- sunscreen and avoid sun!!

7

Anti-phospholipid syndrome

often associated with SLE
= autoimmune hypercoaulable state cause by anti-phospholipid ab causing both venous and arterial clots

CLOTS=
Coagulation defect
Levedo reticularis (skin mottling)
Obstetric (recurrent miscarriages)
Thrombocytopenia

= TREAT with ASPIRIN or WARFARIN