systemic lupus erythmatosus

Question 1

what is it, male vs female and what it affects, age

Answer 1

chronic autoimmune disease- more in females, can be young not only joints and skin, but also heart, kidneys, lungs and bone marrow

Question 2

pathogenesis of SLE- C cells, complexes, complement, apoptosis

Answer 2

environmental (virus) and some genetic component leads to B cell hyperreactivity, forming IMMUNE COMPLEXES (IgG autoantibodies), which damage tissue, mainly via complement apoptotic cells are also not cleared by phagocytosis, hence more immune complexes form against it- these complexes can form in skin, kidney etc

Question 3

presentation of SLE

Answer 3

fatigue, fever, weight loss ie generally feeling ill

Question 4

specific features of SLE including to organs

Answer 4

butterfly rash (facial), alopecia (hair loss), Raynaud’s phenomenon (temporary reduced blood flow) may have more atherosclerosis, and inflammation of kidney/lungs

Question 5

1st step of diagnosis of SLE- different antibodies

Answer 5

lab test for ANTINUCLEAR ANTIBODIES- those that bind to nucleus of cells- will show up via fluorescence: can be different patterns (homogenous/speckled) not too specific, so then anti-dsDNA/sm antibodies (sm=smith) then anti Ro/La antibdoies

Question 6

other tests

Answer 6

increased complement consumption look at FBC (low lymphocytes/platelets) renal test (proteinuria)

Question 7

how to assess severity

Answer 7

look at organs involved, their function, and the autoantibodies expressed

Question 8

how to catch SLE early

Answer 8

look at clinical features eg fatigue, but ALSO ESR/CRP ESR goes up, CRP normal

Question 9

how SLE is classified in terms of severity

Answer 9

mild- joint/skin only moderate- inflammation of some organs eg kidney severe- severe inflammation of organs: heart, lungs, kidney and bone marrow

Question 10

treatment of mild disease

Answer 10

paracetomol/NSAIDs hydroxychloroquine (good for joint pain/skin problems) local corticosteroids

Question 11

treatment of moderate disease

Answer 11

when mild treatments don’t work, give higher dose of corticosteroids, then reduce dose later on

Question 12

treatment of severe disease and side effect

Answer 12

azathioprine and cyclophosphamide (immunosupressive drugs)- problems with fertility for latter

Question 13

bimodal mortality pattern of SLE

Answer 13

early deaths often due to renal failure/CNS disease, late due to MI, as SLE accelerates RATE OF ATHEROSCLEROSIS

Question 14

IL associated with SLE

Answer 14

IL10