Date post: | 25-Dec-2015 |
Category: |
Documents |
Upload: | harvey-carson |
View: | 213 times |
Download: | 0 times |
Aim◦ To give an outline of the diagnosis and
management of SLE
Objectives◦ To describe signs and symptoms of SLE◦ To outline relevant investigations◦ To describe management of SLE
Pathogenesis Epidemiology and risk factors Presentation Investigations Associated illnesses Management Pregnancy and fertility Prognosis Summary
SLE is a heterogeneous, inflammatory, multisystem autoimmune disease in which antinuclear antibodies occur.
SLE is a heterogeneous,
inflammatory, multisystem
autoimmune disease in which
antinuclear antibodies occur. Failure to clear apopetic material efficiently Anti-Ro and Anti–La widespread vasculitis
Prevalence : 50-100/100000 Peak onset 20-40y Female : Male 9:1 Chinese, Southeast Asian (1 in 1000) and
Afro-Caribbean (1 in 500) most common Least common in Northern European origin
(1 in 2800)
Genetic◦ HLA-B8 and DR3 in caucasians, (DR2 in Japanese)
Complement◦ Defective C4 gene
Environmental◦ EBV◦ UV light◦ Drugs:
Chlorpromazine Isoniazid Methyldopa d-penicillamine Hyrdalazine Minocycline
Joints and Muscles ◦ Most common clinical feature◦ Symmetrical small joint arthralgia
Clinically normal examination Skin
◦ Butterfly erythema◦ Vasculitic lesions on fingertips and nail folds◦ Purpura and urticaria◦ 1/3 - photosensitivity
Lungs ◦ Pleurisy◦ Recurrent pleural effusions (exudate)
Cardiovascular◦ Pericarditis◦ Mild myocarditis =/- arrhythmias◦ Raynaud’s◦ Arterial and venous thromboembolism –
antiphospholipid syndrome◦ Atherosclerotic disease
Kidneys◦ glomerulonephritis
CNS◦ Depression◦ Epilepsy◦ Migraine◦ Hemiplegia◦ Ataxia◦ Psychosis◦ Demyelinating syndromes
Eyes◦ Retinal vasculitis hard exudates and
haemorrhages◦ Episcleritis/conjunctivitis/optic neuritis
GI◦ Mouth ulcers◦ Abdominal pain – mesenteric vasculitis
inflammation perforation or infarction
DOPAMINE RASH – 4 out of 11◦ Discoid Rash◦ Oral Ulcers◦ Photosensitivity◦ Arthritis◦ Malar rash◦ Immunological – anti ro, la, smith, dsDNA◦ Neurological changes◦ Elevated ESR◦ Renal involvement◦ ANA +ve◦ Serositis (plurisy and pericarditis)◦ Haematological (haemolytic anaemia, ↓WCC↓plt)
Antiphospholipid syndrome Overlap syndromes: scleroderma, polymyositis,
rheumatoid arthritis and Sjögren's syndrome Prone to other autoimmune conditions such as
thyroiditis Higher incidence of drug allergy Increased risk of infection Increased risk atherosclerosis, hypertension,
dyslipidaemias, diabetes, osteoporosis, avascular necrosis and malignancies (especially non-Hodgkin's lymphoma)
Individual counselling Avoid sun exposure , use sunscreen Analgesia – caution with NSAIDs Corticosteroids – effecitive – but s/e Hydroxychloroquine Cyclphosphamide – life threatening Azothioprine – steroid sparing Methotrexate
Barrier methods of contraception -safest Oestrogens can exacerbate lupus Lowest dose COCP can be used with caution
if no◦ Migraines◦ Thrombosis◦ Hypertension◦ Anticardiolipin antibodies are negative
Increased risk of thrombosis – needs to be counselled.
Fertility is normal Pregnancy is safe in mild or stable disease In severe lupus – disease should be controlled
prior to pregnancy Morbidity - ↑if antiphospholipid antibodies
◦ Recurrent miscarriage◦ Pre-eclampsia◦ IUGR◦ Premature delivery◦ Thrombosis◦ Worsening or renal disease and hypertension
LMWH and low dose aspirin treatment of choice
Improved with earlier recognition and improved management.◦ Morbidity and mortality – higher in patients with
extensive multisystem disease and multiple auto antibodies
◦ Renal involvement poorer prognosis◦ Drug induced lupus usually subsides when the
drug is discontinued.
SLE is a heterogeneous, inflammatory, multisystem autoimmune disease in which
antinuclear antibodies occur. More common in females in their 20-40s More common in Asian and Afro-Caribbean
populations
Relapsing remitting Diagnosis – 4 out of 11 “DOPAMINE RASH” Multiple systems – most common – joint
pain
Initial investigations – Bloods - FBC, ESR, CRP, Complement, ANA, RF, Immunoglobulins, Antiphospholipid antibodies
Management◦ Individual◦ Sunscreen◦ Analgesia◦ Steroids and immunosuppression if severe◦ Contraception if severe
Barrier – fewer risks than hormonal◦ If antiphospholipid
LMWH and aspirin in pregnancy