SLE

Question 1

What are the common signs and symptoms of Lupus?

Answer 1

Remember SOAP BRAIN:
S erositis - Pleurisy, pericarditis
O ral ulcers - usually painless; palate is most
specific
A rthritis – small joints nonerosive
P hotosensitivity – or malar or discoid rash
B lood disorders – low WCC, lymphopenia,
thrombocytopenia, hemolytic anemia
R enal involvement -glomerulonephritis
A utoantibodies (ANA positive in >90%
cases)
I mmunologic tests e.g. low complements
N eurologic disorder - Seizures or psychosis

Question 2

Briefly describe lupus and its pathophysiology

Answer 2

It is an autoimmune disease.
Inadequate T cell suppressor activity with increased B cell activity.
Most patients have antibodies to certain cell nucleus components.

Question 3

What investigations can be done for lupus?

Answer 3

FBC: anaemia and leukopenia are common.
ESR and plasma viscosity are raised in most patients but CRP is normal.
Skin biopsy can be diagnostic.
Renal biopsy can be diagnostic.
Urinalysis for renal function.
Antibody testing:
95% patients are antinuclear antibody positive
Anti-Ro, Anti-La are common
Anti- dsDNA titre rises with disease activity
Antiphospholipid antibodies increase the risk of pregnancy loss and thrombosis

Question 4

How can you diagnose Lupus?

Answer 4

Must have 3 systemic signs/symptoms.

And one immunology result.

Question 5

Briefly describe how Lupus is treated?

Answer 5

Sun protection.
Lifestyle advice to minimise CVD risk.
Hydroxychloroquine for rash and arthralgia.
Other medications- mycophenolate mofetil, azathioprine, rituximab,
Prednisolone for flares.

Question 6

What drugs can trigger an SLE like syndrome?

Answer 6

Isoniazid, minocycline and TNF inhibitors