SLE

Question 1

Definition of SLE?

Answer 1

Chronic autoimmune disease causing immune complex–mediated inflammation in multiple organs (skin, joints, kidneys, CNS, blood).

Question 2

Epidemiology of SLE?

Answer 2

Female predominance (9:1), peak 20–40 yrs.

Question 3

Pathogenesis of SLE?

Answer 3

Loss of self-tolerance → autoantibody formation (ANA, dsDNA, Sm) → immune complexes → complement activation → tissue injury.

Question 4

Main genetic risk?

Answer 4

HLA-DR2, HLA-DR3.

Question 5

Environmental triggers?

Answer 5

UV light, EBV, drugs, smoking.

Question 6

Type of hypersensitivity in SLE?

Answer 6

Type III (immune complex–mediated).

Question 7

Typical skin features?

Answer 7

Malar rash sparing nasolabial folds, discoid lesions, photosensitivity, oral ulcers, alopecia.

Question 8

Typical joint pattern?

Answer 8

Symmetric, non-erosive polyarthritis (hands, wrists).

Question 9

Major renal manifestation?

Answer 9

Proteinuria, haematuria, hypertension → lupus nephritis.

Question 10

Serositis features?

Answer 10

Pleuritis, pericarditis causing pleuritic chest pain.

Question 11

Neuro features?

Answer 11

Seizures, psychosis, myelitis, stroke-like episodes.

Question 12

Haematologic findings?

Answer 12

Anaemia, leucopenia, lymphopenia, thrombocytopenia.

Question 13

Screening antibody for SLE?

Answer 13

ANA (sensitive, not specific).

Question 14

Most specific antibodies for SLE?

Answer 14

Anti-dsDNA, Anti-Sm.

Question 15

Antibody predicting renal disease?

Answer 15

Anti-dsDNA ↑ correlates with lupus nephritis.

Question 16

Complement pattern in active SLE?

Answer 16

Low C3/C4 due to immune complex consumption.

Question 17

Antibodies linked with neonatal lupus?

Answer 17

Anti-Ro (SSA), Anti-La (SSB).

Question 18

Antibody associated with overlap/MCTD?

Answer 18

Anti-RNP.

Question 19

Antiphospholipid antibodies in SLE?

Answer 19

Anticardiolipin, lupus anticoagulant, β2-glycoprotein → thrombosis risk.

Question 20

2019 EULAR/ACR entry criterion for SLE?

Answer 20

Positive ANA ≥1:80.

Question 21

Treatment goal in SLE?

Answer 21

Remission or low activity with minimal steroid exposure.

Question 22

Universal baseline drug in SLE?

Answer 22

Hydroxychloroquine (HCQ).

Question 23

HCQ safe dose?

Answer 23

≤ 5 mg/kg/day actual body weight.

Question 24

HCQ eye monitoring?

Answer 24

Baseline exam + annual after 5 years (earlier if high risk).

Question 25

Steroid strategy?

Answer 25

Pred ≤7.5–10 mg/day for maintenance; pulse IV methylpred for severe flares.

Question 26

Immunosuppressants for maintenance?

Answer 26

Azathioprine or Mycophenolate mofetil (MMF).

Question 27

Induction for severe nephritis?

Answer 27

MMF 2–3 g/day or IV Cyclophosphamide 500 mg q2wk ×6 + steroids.

Question 28

When to biopsy kidney?

Answer 28

Proteinuria ≥500 mg/day, RBC casts, or rising creatinine.

Question 29

ACEi/ARB role in nephritis?

Answer 29

Reduce proteinuria and protect renal function.

Question 30

Belimumab indication?

Answer 30

Active autoantibody-positive SLE refractory to standard therapy.

Question 31

Rituximab indication?

Answer 31

Refractory nephritis, CNS lupus, cytopenias, or vasculitis overlap.

Question 32

Anifrolumab mechanism?

Answer 32

Anti–IFN-α receptor monoclonal antibody; steroid-sparing in non-renal SLE.

Question 33

Flare vs infection clue?

Answer 33

Flare: dsDNA↑ + C3/C4↓ + CRP normal; Infection: CRP high.

Question 34

Drug-induced lupus key antibody?

Answer 34

Anti-histone (renal/CNS rare).

Question 35

Common drugs causing DIL?

Answer 35

Hydralazine, Procainamide, Isoniazid, Minocycline.

Question 36

Pregnancy-safe drugs?

Answer 36

HCQ, Azathioprine, low-dose Prednisolone.

Question 37

Pregnancy contraindicated drugs?

Answer 37

MMF, Cyclophosphamide, Methotrexate.

Question 38

Anti-Ro/La pregnancy implication?

Answer 38

Risk of congenital heart block → fetal echo 16–26 weeks.

Question 39

aPL pregnancy prophylaxis?

Answer 39

Low-dose aspirin ± LMWH depending on history.

Question 40

APS with thrombosis treatment?

Answer 40

Warfarin (INR 2–3; arterial 3 or 2–3 + aspirin). Avoid DOACs if triple-positive.

Question 41

Neuropsychiatric lupus treatment?

Answer 41

High-dose steroids ± Cyclophosphamide or Rituximab.

Question 42

Serositis management?

Answer 42

NSAID ± Colchicine → steroids if refractory.

Question 43

Pulmonary complication unique to SLE?

Answer 43

Shrinking-lung syndrome (restrictive defect, high diaphragm).

Question 44

Vaccines before immunosuppression?

Answer 44

Influenza, Pneumococcal, HPV, Shingrix, COVID-19.

Question 45

Avoid which vaccines on IS?

Answer 45

Live vaccines (MMR, Varicella, Yellow fever).

Question 46

When to give PJP prophylaxis?

Answer 46

Pred ≥20 mg/day ≥4 weeks + another immunosuppressant.

Question 47

Major long-term morbidities?

Answer 47

Nephritis, infection, CVD, steroid toxicity (osteoporosis, AVN).

Question 48

Flare markers to monitor?

Answer 48

dsDNA, C3/C4, urine, creatinine every 3–6 months.

Question 49

Hydroxychloroquine benefits?

Answer 49

↓ flares, ↓ thrombosis, safe in pregnancy, improves survival.

Question 50

Mnemonic HCQ “5 & 5”?

Answer 50

≤5 mg/kg/day, eye screening from year 5.

Question 51

Euro-Lupus regimen mnemonic?

Answer 51

6 half-grams → 500 mg IV Cyclophosphamide ×6 q2wk.

Question 52

APS & DOAC rule?

Answer 52

Avoid DOACs in triple-positive aPL patients.

Question 53

Flare formula mnemonic?

Answer 53

dsDNA ↑ + C ↓ + CRP flat = lupus flare.

Question 54

Ro/La mnemonic?

Answer 54

Ro/La → fetal Echo for congenital heart block.

Question 55

PJP mnemonic?

Answer 55

Pred ≥20 + IS → start prophylaxis.

Question 56

Steroid taper goal mnemonic?

Answer 56

Keep daily Pred ≤7.5–10 mg long-term.

Question 57

Most common cause of mortality in SLE?

Answer 57

Cardiovascular disease (atherosclerosis).

Question 58

Prognosis 10-year survival?

Answer 58

≥90% with modern therapy.

Question 59

Which class of lupus nephritis causes nephrotic-range proteinuria with subepithelial “spike-and-dome” deposits?

Answer 59

Class V (Membranous) lupus nephritis. • Immune complexes deposit on the outer (subepithelial) surface of the GBM. • Presents with nephrotic syndrome (proteinuria > 3.5 g/day, oedema, normal/near-normal Cr). • Often coexists with Class III/IV lesions (“mixed”). 🧠 Mnemonic: “V = Vault of spikes → spike-and-dome.”

Question 60

What is the key autoantibody pattern in drug-induced lupus (DIL)?

Answer 60

Anti-histone antibody positive (ANA +, dsDNA –, complements normal). • Common culprit drugs: Hydralazine, Procainamide, Isoniazid, Minocycline. • Renal/CNS involvement rare. • Resolves after stopping drug. 🧠 Mnemonic: “HISTory of drugs → anti-HISTone.”

Question 61

What total dose and schedule define the Euro-Lupus cyclophosphamide regimen for lupus nephritis?

Answer 61

500 mg IV every 2 weeks × 6 doses = ≈ 3 g total. • Lower-dose alternative to NIH (≈ 12 g total). • Equal renal outcomes with less infection/infertility risk. 🧠 Mnemonic: “6 half-grams = Euro-Lupus.”