Systemic Lupus Erythematosus

Done By: Dalal F. AlanaziMedical student at KFU

Case scenario• A 40 year-old woman presents with a

butterfly rash on her face. She does not use any medication. Other symptoms include arthralgia, alopecia and fatigue, but there is no fever.

1. Which diagnosis is the most likely in view of the clinical presentation?

2. Describe the extent to which other organs can be involved in this disorder.

3. Which laboratory test would you order to establish the diagnosis in this case, and to monitor involvement of other organs than the skin and the joints?

4. Which initial therapeutic measures do you advice?5. Suppose there is no involvement of other organs

initially. What advice would you give the patient regarding check-up visits?

THE OBJECTIVES

#1 The Diagnosis

• Systemic Lupus Erythematosus (SLE).

#2 The organs extent

Describe the extent to which other organs can be involved in this disorder?• Systemic lupus erythematosus (SLE) Multi

systemic autoimmune disease.

• Characterized by arthralgia and rashes being the most common clinical features, While cerebral and renal disease are the most serious problems.

• More than 90% of cases of SLE occur in women, frequently starting at childbearing age.

1997 Revised Criteria- SLE4 OR MORE = SLE

• Malar Rash• Discoid Rash• Photosensitivi

ty• Oral ulcers• Arthritis• Renal

Disorder• Neurologic

Disorder e.g. Seizures,Pychosis

• Hematologic Disorder –Hemolytic Anemia,Leucopenia, Lymphopenia, Thrombocytopenia

• Immunologic disorder Anti-ds DNA,anti-SM,&/or antiphospholipid

Organs can be involved including the Joint, heart, lungs, blood vessels, eyes, brain, kidneys, GIT and skin.

-Joint: arthralgia.-Brain: headache, loss memory or confusion.-Heart/lungs: shortness of breath and/or pain in the chest.-Raynaud phenomenon.-Eyes: dry or puffy eyes.-Brain: meningitis, encephalitis.-Kidney: glomerulonephritis.-GIT: abdominal pain.-Skin: photosensitivity, butterfly.-Nervous system: ataxia.

#3 Laboratory test

- Full blood count may show a leucopenia, lymphopenia and/or thrombocytopenia. Anemia of chronic disease or autoimmune haemolytic aneamia also occurs. The ESR is raised with normal CRP.

- Low serum albumin, Urea and Creatinine only rise when renal disease is advanced (indicators of Lupus nephritis).

- Autoantibodies• The most significant autoantibodies in SLE are

ANA, anti-dsDNA, anti-Ro, anti-Sm and anti-La.

• Antiphospholipid antibodies could be present.• Serum complement C3 and C4 are often

reduced.

- Histology• characteristic histological and

immunofluorescent abnormalities are seen in biopsies from the kidney and skin.

- Diagnostic Imaging:• CT scans of the brain sometimes show infects

or haemorrhage with evidence of cerebral atrophy.

• MRI can detect lesion in spinal cord and may true vasculities from small thrombi.

#4 Therapeutic measures

• General measures:- Avoid excessive exposure to sunlight.- Reduce cardiovascular risk factors

e.g. hypertension, hyperlipidaemia and smoking and so on.

- Mild case: 1. Topical

corticosteroids.2. NSAIDs.3. Antimalarial drugs

(Hydroxychloroquine or Chloroquine).

Symptomatic treatment:

- Severe case:1. High dose oral

corticosteroids.2. Immunosuppressi

ve (Cyclophosphamide).

#5 Advice the patient

• Regular doctor visits can help her keep her treatment plan up-to-date. It also gives her the opportunity to make her doctor aware of new symptoms or a symptom that isn't well controlled by her medications. That even will help in case if she wants to get a pregnant.

THE CONCLUSION

THE PREFERENCES

Kumar & Clark’s Clinical Medicine – Eighth edition

THANK YOU