MSK + Rheum > SLE > Flashcards

SLE Flashcards

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1
Q

What is the female-to-male ratio in systemic lupus erythematosus?

A

SLE is much more common in females with a ratio of 9:1.

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2
Q

Which ethnic groups have a higher prevalence of systemic lupus erythematosus?

A

It is more common in Afro-Caribbeans and Asian communities.

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3
Q

What is the typical age of onset for systemic lupus erythematosus?

A

Onset is usually between 20 and 40 years old.

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4
Q

How has the incidence of systemic lupus erythematosus changed in recent decades?

A

Incidence has risen substantially over the past 50 years, increasing threefold using American College of Rheumatology criteria.

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5
Q

What type of hypersensitivity reaction is involved in systemic lupus erythematosus?

A

SLE is a type 3 hypersensitivity reaction.

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6
Q

Which HLA associations are linked to systemic lupus erythematosus?

A

HLA B8, DR2 and DR3.

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7
Q

What is the underlying mechanism causing SLE?

A

Immune system dysregulation leading to immune complex formation.

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8
Q

Which organs may be affected by immune complex deposition in SLE?

A

The skin, joints, kidneys and brain.

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9
Q

What are general systemic features of SLE?

A

Fatigue, fever, mouth ulcers and lymphadenopathy.

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10
Q

What skin rash is characteristic of SLE and spares the nasolabial folds?

A

The malar or butterfly rash.

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11
Q

What are the features of discoid rash in SLE?

A

A scaly, erythematous, well-demarcated rash in sun-exposed areas that may become pigmented, hyperkeratotic and atrophic.

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12
Q

What photosensitive vascular feature may be seen in SLE?

A

Raynaud’s phenomenon.

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13
Q

What skin pattern described as a net-like discolouration may be seen in SLE?

A

Livedo reticularis.

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14
Q

What type of hair loss occurs in SLE?

A

Non-scarring alopecia.

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15
Q

What type of joint involvement is seen in SLE?

A

Arthralgia and non-erosive arthritis.

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16
Q

What is the most common cardiac manifestation of SLE?

A

Pericarditis.

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17
Q

Which other cardiac condition may occur in SLE?

A

Myocarditis.

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18
Q

What is the most common respiratory manifestation of SLE?

A

Pleurisy and exudative pleural effusions.

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19
Q

What chronic lung condition may occur in SLE?

A

Fibrosing alveolitis.

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20
Q

What renal abnormalities are associated with SLE?

A

Proteinuria and glomerulonephritis, particularly diffuse proliferative glomerulonephritis.

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21
Q

What neuropsychiatric symptoms may occur in SLE?

A

Anxiety, depression, psychosis and seizures.

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22
Q

What percentage of SLE patients are ANA positive?

A

99% are ANA positive.

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23
Q

Why is ANA a useful screening test for SLE?

A

Its high sensitivity makes it a useful rule-out test, though it has low specificity.

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24
Q

What percentage of SLE patients are rheumatoid factor positive?

A

Around 20%.

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25
What are the characteristics of anti-dsDNA antibodies in SLE?
They are highly specific (>99%) but less sensitive (70%).
26
What are the characteristics of anti-Smith antibodies in SLE?
They are highly specific (>99%) with a sensitivity of around 30%.
27
Which additional autoantibodies may be present in SLE?
Anti-U1 RNP, SS-A (anti-Ro) and SS-B (anti-La).
28
What haematological abnormalities may be seen in SLE?
Anaemia, lymphopenia and thrombocytopenia.
29
Why might CRP be normal in active SLE?
CRP may be normal during active disease, and a raised CRP suggests underlying infection.
30
What happens to complement levels during active SLE?
Complement levels, especially C3 and C4, are low due to consumption.
31
Which antibody titre is useful for monitoring SLE disease activity?
Anti-dsDNA titres.
32
What basic treatments are used for SLE?
NSAIDs and sunblock.
33
What is the treatment of choice for SLE?
Hydroxychloroquine.
34
Which medications are considered if SLE involves internal organs?
Prednisolone and cyclophosphamide.
35
What is lupus nephritis?
A severe manifestation of SLE that may lead to end-stage renal disease.
36
Why is urinalysis important in SLE follow-up?
To monitor for proteinuria and detect lupus nephritis early.
37
What is class I lupus nephritis in the WHO classification?
Normal kidney.
38
What is class II lupus nephritis?
Mesangial glomerulonephritis.
39
What is class III lupus nephritis?
Focal (and segmental) proliferative glomerulonephritis.
40
What is class IV lupus nephritis?
Diffuse proliferative glomerulonephritis.
41
What is class V lupus nephritis?
Diffuse membranous glomerulonephritis.
42
What is class VI lupus nephritis?
Sclerosing glomerulonephritis.
43
Which class of lupus nephritis is most common and severe?
Class IV diffuse proliferative glomerulonephritis.
44
What renal biopsy finding is characteristic of class IV lupus nephritis?
Endothelial and mesangial proliferation with a wire-loop appearance.
45
What causes the thickened capillary walls seen in severe lupus nephritis?
Immune complex deposition.
46
What does electron microscopy show in class IV lupus nephritis?
Subendothelial immune complex deposits.
47
What immunofluorescence pattern is seen in lupus nephritis?
A granular appearance.
48
How is hypertension managed in lupus nephritis?
Treat hypertension as part of overall management.
49
What is the initial therapy for class III and IV lupus nephritis?
Glucocorticoids with either mycophenolate or cyclophosphamide.
50
What is the preferred subsequent therapy in lupus nephritis to reduce ESRD risk?
Mycophenolate, preferred over azathioprine.
51
Which autoimmune condition is strongly associated with SLE and causes thrombosis and pregnancy loss?
Anti-phospholipid syndrome.
52
Which antibodies are associated with anti-phospholipid syndrome in SLE?
Anti-cardiolipin, lupus anticoagulant and anti-beta-2 glycoprotein I antibodies.
53
What type of endocarditis is uniquely associated with SLE?
Libman–Sacks endocarditis, a non-bacterial verrucous endocarditis typically affecting the mitral valve.
54
What investigation may be used in Raynaud’s phenomenon to assess for underlying connective tissue disease?
Nailfold capillaroscopy.
55
Which drugs commonly cause drug-induced lupus?
Hydralazine, procainamide, isoniazid, minocycline and anti-TNF agents.
56
Which autoantibody is most characteristic of drug-induced lupus?
Anti-histone antibodies.
57
What organs are typically spared in drug-induced lupus compared with SLE?
Renal and neurological involvement are usually absent.
58
Which maternal antibodies cause neonatal lupus?
Anti-Ro and anti-La antibodies.
59
What cardiac complication can occur in babies with neonatal lupus?
Congenital heart block.
60
What are pregnancy-related risks in women with SLE?
Miscarriage, pre-eclampsia, intrauterine growth restriction and preterm birth.
61
How long should SLE ideally be quiescent before conception?
Six months.
62
Which SLE medication should be continued during pregnancy?
Hydroxychloroquine.
63
Which immunosuppressive drugs must be avoided in pregnancy in SLE?
Mycophenolate, cyclophosphamide and methotrexate.
64
What CRP and ESR pattern suggests an SLE flare?
Raised ESR with normal CRP.
65
What CRP and ESR pattern suggests infection in a patient with SLE?
Both ESR and CRP raised.
66
What long-term vascular complication risk is increased in patients with SLE?
Accelerated atherosclerosis leading to increased myocardial infarction and stroke risk.
67
Why are SLE patients at increased risk of osteoporosis?
Due to chronic inflammation and long-term steroid use.
68
What monitoring is required for patients on hydroxychloroquine?
Annual ophthalmology review for retinal toxicity.
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