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Systemic lupus erythematosus

Systemic lupus erythematosus is a chronic autoimmune connective tissue disease affecting multiple systems.

Incidence of SLE is increased in females and especially those of Afro-Caribbean origin.

Diagnosis is by fulfilling 4 of the 11 criteria of the American College of Rheumatology:
  • Malar rash
  • Discoid rash
  • Photosensitivity
  • Oral ulcers
  • Arthritis
  • Serositis – either pleuritis or pericarditis
  • Renal disorder –persistent proteinuria or cellular casts
  • Neurological disorder – seizures or psychosis
  • Haematological disorder – haemolytic anaemia or leukopeania or lymphopenia or thrombocytopenia
  • Immunologic disorder –
    • anti-dsDNA antibody or anti-Sm antibody or positive antiphospholipid antibodies
    • with either abnormal serum anti-cardiolipin antibody levels or positive lupus anticoagulant or false positive serological testing for syphilis
  • Abnormal ANA titre

Anti-dsDNA is positive in 70% of SLE patients (and 0.5% general population)
ANA is positive in 90% of SLE patients (and 30% general population)

Complications/associations of SLE
  • more prone to infections
  • increased risk of non-Hodgkins lymphoma
  • associated with antiphospholipid syndrome, which confers increased risk of thrombosis and miscarriage
  • lupus glomerulonephritis – occurs in 39%

Blood tests in flares of SLE may show:
  • Raised Anti-dsDNA titres
  • Decreased C3/C4 levels
  • Raised ESR

Management:
  • sunscreen
  • NSAIDs
  • Corticosteroids
  • Hydroxychloroquine
  • DMARDs (azathioprine, methotrexate)


Small print gem: Libman-Sacks endocarditis is an endocarditis found in SLE patients with non-infective vegetations, most commonly affecting the mitral valve.


References:
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Secret collector of interesting anonymised ECGs. Fan of the Bath Photomarathon. Lover of cream teas. [Sarah Hudson] (Your Picture)