SLE

Question 1

What are the signs and symptoms of SLE?

Answer 1

Malar rash which is photosensitive
- can be permanent
- can follow a relapse/remit course

May have discoid rash

Constitutional symptoms: fever, night sweats, weight loss, fatigue

Associated conditions:
- cold hands (Raynaud’s phenomenon)
- dry eyes/mucous membranes (Sjogren’s syndrome)
- PMHx VTE/stroke/MI, recurrent miscarriage (APS)
- Pallor, fatigue, SOB, chest pain (Anaemia of chronic disease)
- fatigue, weight gain, cold sensitivity

Examination
- rash
- nail fold infarcts
- Jacoud’s arthropathy (mimics RA but this is due to tenson contractures not joint destruction - XRay will differentiate)
- resp: pleural effusion with rub, fibrosing alveolitis
- cardiac: pericardial rub (common), valvular incompetence (Libman-Sack endocarditis)
- neurological: finger-nose +/- pronator drift; focal neurology, chorea, ataxia
- renal: HTN, protein/haematuria on dip

Question 2

What are the investigations for suspected SLE?

Answer 2

Full set observations mainly looking for any HTN

ECG - if suspecting pericarditis

Urine dip as part of HTN workup and looking for any nephritic/nephrotic

FBC/UE/LFT/ESR/CRP/immunoglobulins (high)/complement (reduced C4 in increased activity)/TFTs
Diagnostically: ANA/anti-dsDNA

Consider anti-PL

CXR, joint X-Rays

Echo