SLE

Question 1

Characteristics of SLE

Answer 1

Rash, Arthritis, Serositis (heart/lung), Haem (thrombocytopenia, photosensitivity, antibodies (ANA, Ro/La, APLS - lupus, cardiolipin), Immune (anti-dsDNA), Neurological

RASH PAIN

Question 2

Considerations of SLE in pregnancy/pre-pregnancy counselling

Answer 2

Drugs - methotrexate, mycophenalate and cyclosporin are teratogenic

Advise folic acid 5mg

AVOID pregnancy if active disease or pulmonary HTN (high mortality risk)

VTE risk - APLS increases risk
Risks - FGR, miscarriage, pre-term birth

Worsening of renal disease

Fetal implications - neonatal lupus rash and heart block (if ro/la)

Question 3

Which SLE drugs are safe for use in pregnancy?

Answer 3

Hydroxychloroquine
Prednisolone

Question 4

Baseline tests in early pregnancy with SLE?

Answer 4

Check BP, urine, height/weight

Bloods - assess platelets/anaemia, assess renal function

MDT care/referral

Question 5

Ultrasound in SLE pregnancy?

Answer 5

Uterine artery doppler at 20w
Fetal echo if Ro/La from 18-20 weeks to assess for heart block
Growth scans from 26-28 weeks

Question 6

Considerations for delivery (SLE)?

Answer 6

CEFM
Can have vaginal delivery
May need intrapartum steroids if on prednisolone

Question 7

Post-natal considerations in SLE?

Answer 7

VTE - likely will need 6 weeks PN prophylaxis

Post-natal flare - increased risk

Can breastfeed on pred/hydroxy/azathioprine

Consider contraception - avoid oestrogen, e.g. coil

Question 8

Neonatal considerations at birth

Answer 8

Heart block - may require pacing

Neonatal lupus rash - usually resolves by 6 months as maternal antibodies clear