SLE

Question 1

What is it?

Answer 1

Inflammatory autoimmune connective tissue disease

Relapsing and remitting disease

Commonly affects women and asian ethnicity

Shortened life expectancy due to chronic inflammation

Question 2

What is the pathology?

Answer 2

ANA
Antibodies to proteins within the persons own cell nucleus
Immune system targets these proteins and stimulate inflammatory response
Inflammation in body leads to symptoms

Question 3

What are the symptoms?

Answer 3

Fever
Malaise
Weight loss
Raynauds
Skin involvement
-malar rash
-photosensitive rash
-alopecia
-chronic discoid LE- red scaly plaque on face/scalp

Oral mucosal lesions

CNS

• depression and anxiety
• organic brain disease e.g. epileptic seizures

Renal
-interstitial nephritis

Question 4

What are the haematological, MSK and cardiovascular symptoms?

Answer 4

Haemato

• normocytic hypochromic anaemia
• thrombocytopenia
• leukopenia
• haemolytic anaemia due to RBC antibodies

MSK

• arthritis- fingers, wrist and knees affected first
• myalgia

Lung

• recurrent pleurisy and pleural effusions
• SoB
• pulmonary fibrosis

Heart

• pericarditis
• increased risk atherosclerosis

Question 5

What investigations are needed?

Answer 5

Bloods

• FBC=anaemia
• ESR/CRP= ESR raised, CRP normal
• U&Es= deranged if glomerulonephritis present
• Serum ANA- 85% positive
• serum complement levels= C3 and C4 reduced in active disease
• Anti-dsDNA= specific for SLE

Urine dip and BP for renal involvement

Histology- renal involvement

Question 6

What is the management?

Answer 6

Avoid excess sunlight
Control CV risk factors

FIRST line

• NSAIDs
• Steroids- prednisolone
• Hydroxychloroquine

More severe disease

• methotrexate
• tacrolimus
• ciclosporin
• azathioprine

Biological therapies if no response or severe

• rituximab
• belimumab