SLE Flashcards
Systemic lupus erythematous
Inflammatory autoimmune connective tissue disease
More common in women and Asian people
Often takes relapsing-remitting cause
Pathophysiology
Type 3 hypersensitivity reaction
Associated with HLA D8, DR2, DR3
Caused by immune system dysregulation leading to immune complex formation
Immune complex deposition can affect any organ
General features
Fatigue
Fever
Mouth ulcers
Lymphadenopathy
Skin
Malar rash spares nasolabial folds
Discoid rash: scaly, erythematous, well demarcated rash in sun-exposed areas
Photosensitivity
Raynaud’s phenomenon
Livedo reticularis
Non-scarring alopecia
MSK features
Arthralgia
Non-erosive arthritis
CVD features
Pericarditis (most common)
Myocarditis
Respiratory features
Pleurisy
Fibrosing alveolitis
Renal features
Proteinuria
Glomerulonephritis
Neuropsychiatric features
Anxiety and depression
Psychosis
Seizures
Antibodies
99% are ANA positive (high sensitivity but low specificity)
20% are rheumatoid factor positive
Anti-dsDNA: highly specific >99% but less sensitive
Anti-Smith: highly specific >99% but less sensitive
Investigations
Autoantibodies
FBC (normocytic anaemia of chronic disease)
C3 and C4 (levels decreased in active disease)
CRP and ESR (raised with active inflammation)
Immunoglobulins (raised due to activation of B cells)
Urinalysis and urine protein:creatinine ratio for proteinuria in lupus nephritis
Renal biopsy for lupus nephritis
Management
Basics: NSAIDs and sun-block
Hydroxychloroquine
If internal organ involvement consider prednisolone or cyclophosphamide
Complication
CVD is leading cause of death
Infection
Anaemia of chronic disease
Pericarditis
Interstitial lung disease
Lupus nephritis
Neuropsychiatric SLE
Recurrent miscarriage
VTE
