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SLE (DIAGNOSIS (>= 4 features (IMMUNOLOGY
- antiphospholipids…
SLE
DIAGNOSIS
>= 4 features
MSK
- morning stiffness + peripheral swelling
- symmetrical arthralgia
- Jaccoud's arthropathy :arrow_right: reversible subluxation of joints
- Raynaud's
SKIN
- malar rash :red_circle: spares nasolabial folds :red_circle:
- discoid rash - on sun exposed areas :sunny:
- oral ulcers
- livedo reticularis
:heartbeat:
- pleuritis
- pericarditis
- Libmann-sacks endocarditis
- systolic murmus
- HTN
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HEAMATOLOGY
- high ESR
- anaemia of chronic disease
- heamolytic anaemia
- neutropenia
- thrombocytopenia:arrow_right:
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DRUG INDUCED LUPUS
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:checkered_flag:renal, nervous and skin fx are rare
MANAGEMENT
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DMARDs: MTX/sulfasalazine/leflunomide
may need to bridge tx with steroids
CRP and DAS score on each visit
can escalate dose, dual DMARD, offer biologics
NSAIDs for sx
Investigations
ECG - IHD
urine dip: vasculitis, amyloid
Bloods:
RF, anti-CCP
metabolic profile: IHD
pre tx:
- FBC, LFTs, U&Es
- TB, HBV, HCV, HIV
- eye screen
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ANA antibody
also in SSC, sjogren, polymyositis
SJOGREN'S SYNDROME
destruction of exocrine glands
xeropthalmia
xerostomia
enlargement of parotids
asx: SLE/RA
RF +, ANA +, anti-ro, anti-la
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MNEMONIC FOR EXTRAARTICULAR MANIFESTATIONS
FACEBOOKS
F - Felty's syndrome
A - atlanto-axial instability
C - Caplan's syndrome and pulmonary nodules (RA+ pneumoconiosis)
E - effusions
B - blood - normochromic normocytic anaemia
O - oral dryness - sicca syndrome
O - olecranon bursitis
K - kidneys - amyloid, gold, penicillamine
S - sensory neuropathy and scleromalacia
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