Systemic Lupus Erythematosus

Question 1

what is systemic lupus erythematosus (SLE)?

Answer 1

a complex multisystem autoimmune disease, which results from a type III hypersensitivity reaction involving the formation of autoantibodies against cell nuclear autoantigens, which leads to the deposition of immune complexes throughout the body

Question 2

what are the drugs associated with the development of SLE?

Answer 2

• procainamide
• hydralazine
• minocycline
• terbinafine
• isoniazid
• phenytoin
• sulfasalazine
• carbamazepine

Question 3

which virus is associated with the development of SLE?

Answer 3

EBV

Question 4

what are the risk factors for SLE?

Answer 4

• african american
• female
• childbearing age
• HLA-DR2/3
• sunlight exposure

Question 5

what are the symptoms of SLE?

Answer 5

• constitutional (e.g. fatigue, fever, weight loss)
• dermatological (e.g. malar rash, discoid erythematous plaques, scarring alopecia, photosensitivity)
• musculoskeletal (e.g. non-erosive arthritis of the small joints of the hands and feet bilaterally)
• cardiac (e.g. pericarditis with pericardial effusion, coronary artery disease)
• pulmonary (e.g. pleuritis, pulmonary hypertension)
• gastrointestinal (e.g. enteritis, mesenteric vasculitis, pancreatitis)
• renal (e.g. haematuria, red blood cell casts, proteinuria)
• haematological (e.g. anaemia, leucopenia, thrombocytopenia)

Question 6

what are the investigations for SLE?

Answer 6

• urinalysis (e.g. haematuria, proteinuria)
• FBC (e.g. anaemia, leucopenia, thrombocytopenia)
• ESR ↑
• ANA
• anti-dsDNA
• anti-smith
• antiphospholipid
• C ↓

Question 7

how is SLE diagnosed using the systemic lupus erythematosus international collaborating clinics group (SLICC) criteria?

Answer 7

• requires fulfilment of four criteria with at least one clinical and one immunological criterion fulfilled
• alternatively, lupus nephritis with the presence of ANA or anti-dsDNA antibodies

Question 8

what is the management of SLE?

Answer 8

• lifestyle (e.g. avoiding sun exposure, wearing high SPF sunscreen)
• hydroxychloroquine
• methotrexate
• NSAIDs
• prednisolone
• ? azathioprine
• ? mycophenolate mofetil
• ? cyclosporine

Question 9

what is the management of severe SLE or instances of lupus nephritis?

Answer 9

• high-dose oral prednisolone or IV methylprednisolone
• cyclophosphamide
• biologic (e.g. rituximab, belimumab)

Question 10

what are the long-term complications of SLE?

Answer 10

• ESRD
• atherosclerosis
• recurrent miscarriage
• permanent skin damage
• blindness