SLE ☺️

Question 1

Epidemiology
Etiology
Pathophysiology

Answer 1

Female, 20-40s
Afro Caribbean, Asian

AI T3 hypersensitivity
-HLA B8, DR2-3
immune system dysregulation => immune complex formation, deposits in any organ

Question 2

Presentation

• general features
• skin
• MSK
• CV, resp
• renal
• psych

Answer 2

General
-fatigue, fever, mouth ulcers, lymphadenopathy

Skin

• photosensitivity
• malar/discoid in sun exposed areas/non scarring alopecia
• Raynaud’s, nailfold capillaries

MSK
-non erosive arthritis

CV

• pericarditis
• pulmonary fibrosis

Renal
-glomerulonephritis

Psych
-A+D

Question 3

Investigations

Answer 3

AB - ANA, dsDNA, Smith
-Ro, La

High ESR
Low C3,4 (formation of complex => depletion)

Question 4

Management

• lifestyle
• mild

Answer 4

CV risk factors
-exercise, alcohol, smoking, diet
Sun protection

Mild - HCQ + NSAIDS/CS
-can add methotrexate
Moderate - HCQ + immunosuppressive steroid sparing
Severe - lupus nephritis, neuropsychiatric lupus
-intensive immunosuppression + prolonged maintenance to prevent relapse

Belimumab, rituximab can only be used if criteria for use met

Question 5

What is renal nephritis

• assessment
• management

Answer 5

Severe complication => ESRF

• regular urinalysis for proteinuria
• renal biopsy - diffuse proliferative GN due to immune complex deposits (most severe and common)

Management

• HTN treatment
• CS and immunosuppresants (azathiopurine)

Question 6

What is the diagnostic criteria for SLE

Answer 6

Minimum of 4 criteria
-at least 1 clinical criterion
-at least 1 immunological criterion
OR
lupus nephritis as the sole criterion in the presence of ANA or anti dsDNA