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Systemic Lupus Erythematosus

 
 
 
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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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