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SLE (Systemic Lupus Erythematosus) (Treatment (Symptomatic - NSAIDs &…
SLE (Systemic Lupus Erythematosus)
Key Facts
An inflammatory, multisystem autoimmune disorder with arthralgia and rashes as the most common clinical features, and cerebral and renal disease as the most serious problems
Epidemiology
Peak age of onset between 20-40 years - typically women of childbearing age
Commoner in African-Caribbeans and Asians
More common in FEMALES than males
Risk Factors/Aetiology
Pre-menopausal women MOST AFFECTED
Drugs
Genetics - HLA genes have been linked
UV light can trigger flares of SLE
Family history
Epstein-Barr virus is a potential trigger of SLE
Cause unkownn
Pathophysiology
The removal of the leftovers of apoptosis by phagocytes is inefficient, so they are transferred to lymphoid tissue, they can be taken up by antigen-presenting cells
These self-antigens are presented to T cells, which stimulate B cells to produce autoantibodies directed against the antigens
These are usually hidden from the immune system
Clinical Presentation
Glomerulonephritis with persistent proteinuria
Seizures - no causative agent
Photosensitive rash
Psychosis
Erythema in a BUTTERFLY DISTRIBUTION
Mouth ulcers - very common
Symptoms similar to rheumatoid arthritis
Differential Diagnosis
Acute pericarditis, antiphospholipid syndrome, B-cell lymphoma, fibromyalgia, scleroderma, Sjogren syndrome
Diagnosis
Histology to see deposition of IgG and complement
MRI and CT for lesions in brain
Think infection, serositis or arthritis if CRP raised
Blood
Raised ESR
Normal CRP
May show leucopenia, lymphopenia and/or thrombocytopenia
Anaemia of chronic disease or autoimmune haemolytic anaemia
Urea and creatinine ONLY raised if renal disease is advanced
Autoantibodies
Serum complement - C3 & C4 are REDUCED
Think SLE if ESR RAISED but CRP NORMAL
Treatment
Symptomatic - NSAIDs & corticosteroids
Topical corticosteroids for rashes
Treat blood pressure and give statins to control CVD risk
Antimalarial drugs helps mild skin disease, fatigue and arthralgia that can't be controlled by NSAIDs
Prevent rashes with high factor suncream
Reduce CVD risk factors e.g. smoking cessation & weight loss
Immunosuppressants
Reduce sunlight exposure
Acute SLE - IV CYCLOPHOSPHAMIDE & HIGH DOSE PREDNISOLONE