SLE
BY
DR ADNAN BASHIR
HAMDARD UNIVERSITY
HOSPITAL
Agenda
Definition of SLE
Causes of SLE
Clinical Picture of SLE
Investigations of SLE
Treatment of SLE
Definition
Systemic lupus erythematosus (SLE)
is a multi-system auto-immune
disease that is caused by tissue
damage resulting from antibody and
complement fixing immune complex
deposition
It is characterized by states of
exacerbation and remission
Definition (Cont.)
The immune system loses the ability to
differentiate between foreign cells and
it’s own cells and tissues
Antibodies against the immune system
are formed
The immune complexes that are
formed build up in the tissue causing
inflammation, injury to the tissue, and
pain
INCIDENCE OF
LUPUS
Between 500,000 to 1.5 million
Americans have lupus.
80-90% of lupus patients are female.
80% of lupus patients are between 15
and 45 years of age.
Lupus affects more African
Americans, Asian Americans,
Hispanics, and Native Americans than
Caucasians.
WHAT CAUSES
LUPUS?
Geneti Hormone
cs s
Environme
nt
Etiology
The specific cause is unknown
Genetic factors may play a role
Environmental agents
Drugs or other chemical agents
Dietary factors
Ultraviolet radiation
Infectious agents
LUPUS IS…
Different for each person.
A disease that ranges from mild to
life threatening.
Characterized by flares and
remissions.
TYPES OF LUPUS
Discoid or Cutaneous Lupus
(DLE)
Drug Induced Lupus (DIL)
Neonatal Lupus
Systemic Lupus Erythematous
(SLE)
DISCOID LUPUS
Affects the skin, hair or mucous
membranes.
Identified by a rash or lesions.
Diagnosed by biopsy of rash.
10% will evolve into SLE.
Treatment includes topical or
interlesional steroids;
antimalarials.
Discoid Rash
DRUG INDUCED LUPUS
Develops after long-term use of certain
medications.
Most common in men over 50 years old.
Symptoms are similar to SLE.
Most important treatment is to recognize
medication and discontinue use.
Once medication is stopped, symptoms
usually disappear completely within 6
months.
NEONATAL LUPUS
Occurs when the mother’s antibodies
cross over the placenta to the baby.
Can affect the skin, heart, liver and/or
blood of the fetus and newborn.
Good prenatal care can prevent most
problems.
SYSTEMIC LUPUS
ERYTHEMATOSUS
Can affect any organ in the body
including the joints, skin, lungs, heart,
blood, kidney, or nervous system.
Can range from mild to life
threatening.
No two people will have identical
symptoms.
COMMON
SYMPTOMS OF SLE
Achy joints
Fever
Fatigue
Skin Rashes
OTHER
LUPUS SYMPTOMS
Chest pain Headache
Hair loss Dizziness
Mouth sores Depression
Photosensitivity Seizures
Anemia Memory disturbances
Repeated miscarriages
ORGAN
INVOLVEMENT
WITH LUPUS
Kidneys Blood vessels
Lungs Blood
Central Heart
nervous
system
DIAGNOSING LUPUS
Medical history (including family
history)
Complete physical examination
Laboratory tests
Skin or kidney biopsy
ACR DIAGNOSTIC
CRITERIA
Skin criteria Systemic criteria
1. Butterfly rash 5. Arthritis
2. Discoid rash 6. Serositis
3. Photosensitivity 7. Kidney disorder
8. Neurologic disorder
4. Oral ulcers
Laboratory criteria
9. Hematologic
abnormalities
10. Immunologic disorder
11. Antinuclear antibody
Criterion Definition
Malar Rash Rash over the cheeks
Discoid Rash Red raised patches
DIAGNOSIS
Photosensitivity
Reaction to sunlight, resulting in the development of or
increase in skin rash
Oral Ulcers Ulcers in the nose or mouth, usually painless
Arthritis Nonerosive arthritis involving two or more peripheral
joints (arthritis in which the bones around the joints do
not become destroyed)
Serositis Pleuritis or pericarditis (inflammation of the lining of the
lung or heart)
Renal Disorder Excessive protein in the urine (greater than 0.5 gm/day
or 3+ on test sticks) and/or cellular casts (abnormal
elements the urine, derived from red and/or white cells
and/or kidney tubule cells)
Criterion Definition
Neurologic Seizures (convulsions) and/or psychosis in the
Disorder absence of drugs or metabolic disturbances which are
DIAGNOSIS known to cause such effects
Hematologic Hemolytic anemia , leukopenia , lymphopenia or
Disorder thrombocytopenia. The leukopenia and lymphopenia
must be detected on two or more occasions. The
thrombocytopenia must be detected in the absence of
drugs known to induce it.
Antinuclear Positive test for antinuclear antibodies (ANA) in the
Antibody absence of drugs known to induce it.
Immunologic Positive anti-double stranded anti-DNA test, positive
Disorder anti-Sm test, positive antiphospholipid antibody such
as anticardiolipin, or false positive syphilis test
(VDRL).
Adapted from: Tan, E.M., et. al. The 1982 Revised Criteria for the Classification of SLE. Arth
Rheum 25: 1271-1277.
Malar Rash
Oral Ulcers
Systemic Lupus Erythematosus
Head and Neck Manifestations
Malar rash first sign in 50%
Erythematous
maculopapular eruption
after sun exposure
Oral ulceration
Musculoskeletal
System
All joints can be affected,
however the wrists, knees,
ankles, elbows, and
shoulders are most common
Musculoskeletal System
(Cont.)
Hand deformities can include ulnar
deviation and subluxation, swan neck
deformities, and subluxation of thumb
interphalangeal joints
Reversible subluxation has been
observed in the knees
Cardiovascular System
Pericarditis is the most
common cardiac
manifestation
myocarditis
Endocarditis with
characteristic lesion
of the cardiac valve
Pulmonary System
Pleurisy is the most common
manifestation of pulmonary
involvement
Interstitial lung disease
Pulmonary embolisms
Gastrointestinal Sytem
Difficulty swallowing
Gastric reflux disease
Anorexia, nausea, or vomiting may be
present
Pancreatitis
Raynaud’s Phenomena
Http://[Link]/doia
Renal manifestations
Tend to appear within the 1st 2yrs of
SLE
Almost ½ have asymptomatic urine
abnormalities
Proteinuria - dominant feature
Haematuria – almost always present
but not in isolation
Nervous System
Neuropsychiatric manifestations of
lupus occur frequently
May be mild to severe
Any location in the nerve system may
be affected (brain, spinal cord,
peripheral system)
Nervous System (Cont.)
Central Nerve
System
Acute confusional
state
Psychosis
Anxiety disorder
Headache
Cerebrovascular
disease
Nervous System (Cont.)
Peripheral Nerve System
Cranial neuropathy
Mononeuropathy
Polyneuropathy
COMMON LABORATORY
TESTS
Antinuclear Antibody (ANA)
Anti DNA
Anti-Sm
Anti-RNP
Anti-Ro
Anti-La
OTHER LABORATORY
TESTS
CBC (RBC, WBC, Rheumatoid
platelets) Factor
Urinalysis Skin biopsy
Sedimentation Rate (ESR) Kidney Biopsy
EFFECT OF LABORATORY TESTS
WITH INCREASED LUPUS
ACTIVITY
C reactive protein (CRP)
Sedimentation rate (ESR) CBC (WBC,
Anti DNA RBC,
Liver and Kidney platelets)
Function tests Complement
CPK Serum albumin
Urine protein or cell
casts
LUPUS TREATMENT
Team effort
Tailored
Tentative
LUPUS PHYSICIANS
Family Practitioner
Internist
Rheumatologist
Clinical Immunologist
Dermatologist
Nephrologist
Other specialists
COMMON
LUPUS MEDICATIONS
NSAIDs
Antimalarials
Corticosteroids
Immunosuppressants
Investigational
(research)
NSAIDs
Aspirin
Ibuprofen
Indomethacin
CORTICOSTEROIDS
Prednisone
Prednisolone
Methylprednisolone
Hydrocortisone
ANTIMALARIALS
Chloroquine
IMMUNE SUPPRESSANTS
Cyclophosphamide
Azathioprine
PREVENTIVE MEASURES
Sun precautions
Rest
Nutrition/diet
Exercise
Moist heat
Prevent infection
Don’t smoke
Thank You