Systemic lupus erythematosus

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Rawalpindi Medical college

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Systemic lupus erythematosus

  1. 1. SYSTEMIC LUPUS ERYTHEMATOSUS Dr Nadim Iqbal Sheikh Assoc. Prof. Medicine Rawalpindi General Hospital
  2. 2. SLE  DEFINITION: An inflammatory disease which results in multisystem involvement and has a varied clinical presentation – No uncommon – Male:female ratio 1:10 – Most common in African American women (1:250)
  3. 3. Predisposing factors HLA DR3 Complement deficiency Increased Oestrogens or reduced androgens Drugs, viruses Tissue Damage Reduced T Cell function Immune complexes Autoantibody Production Increased B cell stimulation
  4. 4. Drugs Causing SLE – – – – – – Hydralazine Procainamaide Quinidine Phenytoin Isoniazid chlorpromazine
  5. 5. Drug Induced SLE – Hydralazine  – – – – 50% may develop ANA, only 10% develop lupus like disease Anti ds DNA usually absent Cerebral and renal invovement rare Antihistone antibodies in 95% Complement deficiencies are uncommon
  6. 6. Non-organ-specific antibodies and their frequency in SLE Anti ds DNA Highly specific for SLE 90% Ant ss DNA Non specific 60% Anti-nRNP Low titre in SLE, high titre in MCTD 40% Anti Sm More common in blacks 25% Anti La(SSB) Sjogrens syndrome 15% Anti SL Fever and lymphadenopathy 8% Anti DNA histone 95% in drug induced SLE 50% Anticytoplasmic antibodies Anti Ro(SSA) ANA negative SLE andjogren’s Syndrome 40%
  7. 7. ARA Criteria for Dx of SLE  Criteria % – Malar rash – Discoid Rash 62 – Photosensitivity 16 22 86 – Oral/nasal ulcers – Non-deforming arthritis 30
  8. 8.  Criteria – – – – – Renal Disease Neurological disease (psychosis/seizures) Haem(↓Hb,WBC,Platelets Serositis  (pleurisy/percarditis) ARA Revised Criteria 1982 % 24 19 50 30
  9. 9. Drug Therapy for SLE  Drug – NSAIDs – Antimalarials cutaneous disease – Corticosteroids – Indications synovitis & mild systemic illness synovitis & Moderate to severe systemic disease including vasculitis, neurpathy, nephritis, vasculitis and otyher vital organs ImmunosuppressantsSevere disease including nephritis
  10. 10. Pregnancy and SLE  Fertility is usually normal except in severe disease – – – – – – – No major contraindication to pregnancy For Contraception Barrier methods rather than pill are preferable as Oestrogens can precipitate relapse Recurrent miscarriages occur (?antiphospholipid syndrome) Postpartum exacerbations are not infrequent Continue usual treatment Control HTN well Eetal loss in severe disease and APL syndrome
  11. 11. PROGNOSIS    In 1950’s 5 year survival was 50% In 1990’s 10 year survival is in excess of 90% Patients with renal and neurological involvement have poorer prognosis
  12. 12. Issues in management     Reduction of steroids any further leads to joint pains, elevation of ESR and CRP with depression of Complement levels Safety of hydoxychloroquine with a solitary eye Counselling regarding marriage and having family (steroids and immunosupressant) Anticonvulsants (how long to continue as fits are likely to recur in secondary epilepsy)
  13. 13. UPDATE     Fully active, going to college Steroids withdrawn Dose of azathioprine increased Eye surgery with placement of artificial eye done.
  14. 14. THANK YOU

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