Systemic Lupus Erythematosus Flashcards Preview

Rheumatology > Systemic Lupus Erythematosus > Flashcards

Flashcards in Systemic Lupus Erythematosus Deck (19)
Loading flashcards...
1
Q

What is SLE?

A

A multisystemic autoimmune disease

2
Q

What causes SLE (pathophysiology)?

A
  • Autoantibodies are made against a variety of autoantigens (ANA) which form immune complexes.
  • Inadequate T cell suppressor activity and increased B cell activity.
  • Inadequate clearance of the immune complexes causes the host to amount an immune response, causing tissue inflammation and damage.
3
Q

What are some risk factors for SLE?

A
  • Women
  • Child bearing age
  • Commoner in African-Caribbean’s and Asians
  • 1st/2nd degree relative with SLE
4
Q

What are the common clinical features of SLE?

SOAP BRAIN

A

S - Serositis (pleurisy, pericarditis)
O - Oral ulcers, mostly on the palate
A - Arthritis, small joints non erosive
P - Photosensitivity, malar or discoid rash

B - Blood disorders, low WCC, lymphopenia, thrombocytopenia, haemolytic anaemia
R - Renal involvement (glomerulonephritis)
A - Autoantibodies (ANA positive)
I - Immunologic tests (low complement)
N - Neurological disorder - Seizures or psychosis

5
Q

What are some general, non specific symptoms of SLE?

A
  • Malaise
  • Fatigue
  • Myalgia
  • Fever
6
Q

What are the best three blood tests for lupus?

A
  1. Anti-dsDNA antibody titres
  2. Complement - low C3 and C4, denotes consumption of complement and increased C3d/C4d the degradation products
  3. Raised ESR
7
Q

Describe the immunology of SLE?

A
  1. 95% are ANA positive
  2. 60% are anti-dsDNA positive
  3. 20-30% ENA - anti-Ro, anti-La
  4. 40% are RhF positive
  5. Antiphospholipid antibodies
8
Q

What other autoimmune conditions can SLE present with?

A
  • Sjogrens

- Autoimmune thyroid disease

9
Q

What is the standard work up for a suspected SLE patient other than immunological studies?

A
  • BP
  • Urinalysis - Casts or proteins
  • FBC, U+E, LFT, CRP (usually normal)
  • Skin or renal biopsies can be diagnostic
10
Q

What does raised ESR but normal CRP make you consider?

A

LUPUS

11
Q

What does raised ESR and raised CRP make you consider?

A
  • Infection
  • Serositis
  • Arthritis
    aka NOT LUPUS
12
Q

What drugs can cause SLE?

Does it remit once the drug is stopped?

A
  • Isoniazid
  • Hydralazine (if over 50mg)
  • Procainamide
  • Phenytoin
  • Anti-TNF agents

Yes

13
Q

What is the general management for SLE?

A
  • High factor sun cream
  • Screen for comorbidities and medication toxicity
  • Topical steroids firstline for skin flares
14
Q

What is the pharmacological management for SLE?

A
  • Hydroxychloroquine
  • NSAIDs unless renal disease for joint/skin symptoms
  • Azathioprine/methotrexate/mycophenolate motefil as steroid sparing agents
  • Belilumab as add on if antibody positive and high disease activity
  • Short course prednisolone for flares
15
Q

What symptoms occur with drug induced SLE?

A
  • Skin and lung signs prevail

- CNS and renal system rarely affected

16
Q

How do you treat lupus nephritis?

A
  1. ACE-i/ARB for renal protection
  2. Hydroxychloroquine for systemic disease
  3. If severe: Mycophenolate, glucocorticoids, cyclophosphamide, rituximab
17
Q

Antiphospholipid syndrome presents in 20-30% of patients with SLE. What cause it cause? (CLOTS)

What is the treatment?

A

C - Coagulation defect (arterial/venous)
L - Livedo reticularis
O - Obstetric (recurrent miscarriage)
T - Thombocytopenia/Thombotic tendency

  • Treat with anticoagulation
18
Q

How many clinical features do you need to diagnose lupus?

A

4 - At least 1 clinical and 1 laboratory

19
Q

What risk is increased with lupus?

A

CVD