lupus

Question 1

what is systemic lupus erythematosus

Answer 1

an inflammatory autoimmune connective tissue disease

Question 2

leading causes of death in lupus

Answer 2

cardiovascular disease and infection

Question 3

pathophysiology of lupus

Answer 3

• characterised by ant-nuclear antibodies
• these are antibodies to proteins within the persons own cell nucleus
• immune system targets these proteins
• when immune system is activated by these antibodies targeting proteins in the cell nucleus it generates an inflammatory response
• inflammation in the full body

Question 4

symptoms of lupus

Answer 4

• Fatigue
• Weight loss
• Arthralgia (joint pain) and non-erosive arthritis
• Myalgia (muscle pain)
• Fever
• Photosensitive malar rash. This is a “butterfly” shaped rash worse with sunlight.
• Lymphadenopathy and splenomegaly
• Shortness of breath
• Pleuritic chest pain
• Mouth ulcers
• Hair loss
• Raynaud’s phenomenon

Question 5

investigations

Answer 5

• ANA
• anti-dsDNA
• anti-smith
• full blood count (normocytic anaemia)
• C3 and C4 levels decreased in active disease
• CRP and ESR raised in active inflammation
• immunoglobulins raised
• urinalysis for urine protein:creatine rato in lupus nephritis
• renal biopsy

Question 6

complications of lupus

Answer 6

• hypertension and coronary artery disease
• infection
• anaemia of chronic disease
• leucopenia, neutropenia, thrombocytopenia
• pericarditis
• pleuritis
• ILD - pulmonary fibrosis
• lupus nephritis
• optic neuritis, transverse myelitis or psychosis
• recurrent miscarriage
• venous thromboembolism

Question 7

first line treatment

Answer 7

• NSAIDS
• steroids (prenisolone)
• hydroxychloroquine (first line for mild)
• suncream and sun avoidance

Question 8

name some other commonly used immunosuppressants for resistant or more severe lupus

Answer 8

• methotrexate
• mycophenolate mofetil
• azathioprine
• tacrolimus
• leflunomide
• ciclosporin

Question 9

name some biological therapies for patients with severe disease or those who don’t respond to treatment

Answer 9

• rituximab

- belimumab