SLE

Lupus is a systemic autoimmune disease that occurs when your body’s immune system attacks your own tissues and organs. Inflammation caused by lupus can affect many different body systems for example joints, skin, kidneys, blood cells, brain, heart, and lungs.

Clinical features

From top to bottom

Fever

Depression

Alopecia

Seizures

Psychosis

Ataxia

Retinal vasculitis

Skin (Butterfly rash, discoid rash, photosensitivity, urticaria)

Mouth ulcers

Cervical lymphadenopathy

Cardiovascular (Pericarditis, endocarditis, pericardial effusion)

Respiratory (Pleuritis, pleural effusion)

Abdominal pain

Splenomegaly

Glomerulonephritis

Arthritis- hands, and feet mainly

Raynauds phenomenon

Avascular necrosis of femur

Peripheral neuropathy

Others

Myalgia

Anaemia

Leucopenia

Lymphopenia

Thrombocytopenia

Diagnosis

ANA- Positive in 95 percent

dsDNA antibodies are 90 percent specific but only present in  60 %

ENA antibodies- Highly specific

Note- First do ANA and if positive then do ENA antibodies and ds DNA

Others

ESR

Crp

Rheumatoid factor

Other tests depending on suspected complications

Management options

Referral to rheumatologist

NSAIDs

Antimalarial such as hydroxychloroquine

Corticosteroids

Immunosuppressants such as Azathioprine

Cyclophosphamide and pregnancy

Cyclophosphamide is contraindicated in pregnancy.

She can start cyclophosphamide but she needs to stop cyclophosphamide at least 3 months before intending to plan for pregnancy

She needs to go on appropriate contraception while on cyclophosphamide.

She and her partner can consider egg harvesting or sperm banking before starting treatment on cyclophosphamide

Complications

Early miscarriage

Intrauterine growth retardation of the baby

Preterm delivery

Flareup of SLE

Risk of preeclampsia

Risk of thromboembolism

Lupus nephritis

BUTTERFLY RASH IN SLE

DISCOID RASH IN SLE