Overview
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- Diagnosis - when lupus was diagnosed, active or in remission, causes of flares
- Family history of SLE
- Manifestations - systemic, skin, MSK, cardiovascular, respiratory, neurologic, haematologic, renal
- Management - sun avoidance, smoking cessation, hydroxychloroquine, immunosuppression
Risk Factors for Systemic Lupus Erythematosus
- Family history of SLE
- Female sex
- Smoking
- Obesity
Precipitants of Lupus Flares
- UV light
- Stress
- Infections
- Pregnancy
- Rapid tapering of immunosuppression
- Drugs - procainamide, hydralazine, minocycline, quinidine, diltiazem, isoniazid, phenytoin, carbamazepine
Manifestations
Manifestations of Systemic Lupus Erythematosus
- Systemic - fatigue, fevers, weight loss
- Skin - photosensitivity (malar) rash, discoid rash, alopecia
- Musculoskeletal - arthralgias, non-erosive arthritis, myalgias, tenosynovitis
- Cardiovascular - pericarditis, Raynaud's phenomenon, Libman Sacks (sterile) endocarditis, valvular disease, risk of atherosclerosis
- Respiratory - pleurisy, interstitial lung disease
- Neurologic (neuropsychiatric lupus) - cognitive dysfunction, psychosis, seizures
- Haematologic - antiphospholipid syndrome, lymphopaenia, anaemia, thrombocytopaenia
- Renal - lupus nephritis
Management
Management Options
Non-Pharmacologic
- Sun avoidance / use of sunscreen
- Smoking cessation
Pharmacologic
- Hydroxychloroquine
- NSAIDs
- Immunosuppression - mycophenolate, cyclophosphamide, azathioprine, leflunomide, cyclosporin
- Belimumab (anti-BLys/BAFF)
Treatment of Manifestations
- Skin disease - topical or intralesional steroids
- Raynaud's - cold avoidance, smoking cessation, calcium channel blockers, topical nitrates, PDE5 inhibitors, prostacyclin
- Antiphospholipid syndrome - anticoagulation
- Lupus nephritis (class III / IV) - immunosuppression
Pearls
- Aim to prevent further damage
- Minimise use of steroids
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