systemic lupus erythmatosous

Question 1

define SLE

Answer 1

SLE is an inflammatory autoimmune connective tissue disorde

Question 2

pathophysiology of SLE (full)

Answer 2

1. B and T cells that react against self-antigens are usually destroyed in the bone marrow
2. In SLE, these cells survive due to a defect in central or peripheral tolerance.
3. Increased defective clearance of apoptotic cells, combined with the production of autoantibodies leads to the formation of immune complexes.
4. These immune complexes are deposited in tissues and trigger a complement cascade, leading to further inflammation.
5. The persistent inflammation of organs can lead to damage (e.g. glomerulonephritis).

Question 3

pathophysiology of SLE (shortened)

Answer 3

aNA and antiDsDNA antibodies attack soft tissue causing chronic inflammation and damage

Question 4

what type of hypersensitivity is SLE

Answer 4

HYPERSENSISITIVTY TYPE 3 - antigen antibody complex deposition

Question 5

who is at high risk of SLE

Answer 5

• Asian, African, Caribbean, and Hispanic patients
• middle-aged adults
• women

Question 6

risk factors for SLE

Answer 6

• female
• drugs
• genetics (HLAB8/DR2/DR3)

Question 7

signs and symptoms of SLE

Answer 7

• Fatigue
• Weight loss
• Arthralgia (joint pain)
• Non-erosive arthritis
• Myalgia (muscle pain)
• Fever
• Lymphadenopathy
• Splenomegaly
• Shortness of breath
• Pleuritic chest pain
• Mouth ulcers
• Hair loss
• Raynaud’s phenomenon
• Oedema (due to nephritis)
• Malar/butterfly rash (across the nose and cheeks and worsened/triggered by sunlight)

Question 8

what investigations do you do for SLE

Answer 8

1. bloods
2. urine dipstick/urinalysis
3. serology
4. renal biopsy

Question 9

what do bloods for SLE show

Answer 9

1. anaemia (normocytic)
2. raised ESR, normal CRP
3. decreased C3 &C4

Question 10

what does urinalysis of SLE show

Answer 10

• proteinuria (in lupus nephritis)
• haematuria

Question 11

what does serology for SLE show

Answer 11

• ANA Ab’s (85% of patients)
• Anti dsDNA Ab’s (50% of patients)

Question 12

which antibodies are more useful for SLE diagnosis

Answer 12

anti-dsDNA are highly specific so if present, high indication of SLE

Question 13

how to look for specific antibodies

Answer 13

An extractable nuclear antigen looks for specific antibodies to distinguish between specific tissue disorders

Question 14

what is antiphospholipid syndrome

Answer 14

Antiphospholipid antibodies/syndrome can occur secondary to SLE in 40% of patients.

Question 15

how to establish a diagnosis for SLE

Answer 15

Patients are diagnosed using the European League Against Rheumatism or American College of Rheumatology criteria.

Question 16

first line treatment for SLE

Answer 16

Hydroxychloroquine, NSAIDS, and steroids

Question 17

treatment for more resitant forms of SLE

Answer 17

DMARDs and biological therapies (rituximab and belimumab)

Question 18

what is Discoid Lupus Erythematosus

Answer 18

affects the skin and is common in darker-skinned patients.
Lesions appear on the skin, and they are photosensitive.

Question 19

symptoms of discoid lupus erythematosus

Answer 19

• Scarring alopecia
• hyperpigmentation
• hypopigmentation

Question 20

how to diagnose discoid lupus erythematosus

Answer 20

skin biopsy

Question 21

treatment of discoid lupus erythematosus

Answer 21

• sun protection
• steroids
• hydroxychloroquine.

Question 22

does SLE cause illness/death

Answer 22

no illness/death are due to a complication of SLE

Question 23

complications of SLE

Answer 23

• cardiovascular disease
• infection
• pericarditis
• pleuritis
• interstitial lung disease
• lupus nephritis
• neuropsychiatric SLE
• recurrent miscarriage
• venous thromboembolism