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SLE             BYDR. EHAB ELTORABY     MD GENERAL MEDICINERHEUMATOLOGY &IMMUNOLOGY UNIT
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 dama...
Definition (Cont.)   The immune system loses the ability to    differentiate between foreign cells and    it’s own cells ...
INCIDENCE OF LUPUS   Between 500,000 to 1.5 million    Americans have lupus.   80-90% of lupus patients are female.   8...
WHAT CAUSES LUPUS? Genetics   Hormones     Environment
Etiology   The specific cause is unknown   Genetic factors may play a role   Environmental agents   Drugs or other che...
LUPUS IS…   Different for each person.   A disease that ranges from mild to life    threatening.   Characterized by fla...
TYPES OF LUPUS   Discoid or Cutaneous Lupus (DLE)   Drug Induced Lupus (DIL)   Neonatal Lupus   Systemic Lupus Erythem...
DISCOID LUPUS   Affects the skin, hair or mucous    membranes.   Identified by a rash or lesions.   Diagnosed by biopsy...
Discoid Rash
DRUG INDUCED LUPUS   Develops after long-term use of certain    medications.   Most common in men over 50 years old.   ...
NEONATAL LUPUS   Occurs when the mother’s antibodies cross over    the placenta to the baby.   Can affect the skin, hear...
SYSTEMIC LUPUS       ERYTHEMATOSUS   Can affect any organ in the body    including the joints, skin, lungs, heart,    blo...
COMMONSYMPTOMS OF SLE    Achy joints    Fever    Fatigue    Skin Rashes
OTHER            LUPUS SYMPTOMS    Chest pain                Headache    Hair loss                 Dizziness    Mouth...
ORGAN INVOLVEMENT       WITH LUPUS   Kidneys              Blood vessels   Lungs                Blood   Central nervou...
DIAGNOSING LUPUS   Medical history (including family history)   Complete physical examination   Laboratory tests   Ski...
ACR DIAGNOSTIC CRITERIASkin criteria             Systemic criteria1.   Butterfly rash       5.   Arthritis2.   Discoid ras...
Criterion                                      Definition    Malar Rash     Rash over the cheeks  Discoid Rash     Red rai...
Criterion                                                    Definition   Neurologic      Seizures (convulsions) and/or ps...
Malar Rash
Oral Ulcers
Systemic Lupus Erythematosus   Head and Neck Manifestations     Malar rash first sign in 50%     Erythematous maculopap...
Musculoskeletal System    All joints can be affected,     however the wrists, knees,     ankles, elbows, and shoulders ar...
Musculoskeletal System(Cont.)    Hand deformities can include ulnar     deviation and subluxation, swan neck     deformit...
Cardiovascular System Pericarditis is the most  common cardiac  manifestation myocarditis Endocarditis with  characteri...
Pulmonary System   Pleurisy is the most common    manifestation of pulmonary    involvement   Interstitial lung disease...
Gastrointestinal Sytem   Difficulty swallowing   Gastric reflux disease   Anorexia, nausea, or vomiting may be present...
Raynaud’s Phenomena     Http://www.dermis.net/doi      a
Renal manifestations   Tend to appear within the 1st 2yrs of SLE   Almost ½ have asymptomatic urine    abnormalities    ...
Nervous System   Neuropsychiatric manifestations of    lupus occur frequently       May be mild to severe       Any loc...
Nervous System (Cont.)   Central Nerve System      Acute confusional       state      Psychosis      Anxiety disorder ...
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, platelets)      Rheumatoid Factor   Urinalysis                  ...
EFFECT OF LABORATORY TESTS      WITH INCREASED LUPUS ACTIVITYC reactive protein (CRP) Sedimentation rate (ESR)      C...
LUPUS TREATMENT    Team effort    Tailored    Tentative
LUPUS PHYSICIANS    Family Practitioner    Internist    Rheumatologist    Clinical Immunologist    Dermatologist    ...
COMMONLUPUS 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 in...
Th a n k Y o u
SLE
SLE
SLE
SLE
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SLE

  1. 1. SLE BYDR. EHAB ELTORABY MD GENERAL MEDICINERHEUMATOLOGY &IMMUNOLOGY UNIT
  2. 2. Agenda Definition of SLE Causes of SLE Clinical Picture of SLE Investigations of SLE Treatment of SLE
  3. 3. 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
  4. 4. 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
  5. 5. 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.
  6. 6. WHAT CAUSES LUPUS? Genetics Hormones Environment
  7. 7. 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
  8. 8. LUPUS IS… Different for each person. A disease that ranges from mild to life threatening. Characterized by flares and remissions.
  9. 9. TYPES OF LUPUS Discoid or Cutaneous Lupus (DLE) Drug Induced Lupus (DIL) Neonatal Lupus Systemic Lupus Erythematous (SLE)
  10. 10. 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.
  11. 11. Discoid Rash
  12. 12. 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.
  13. 13. 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.
  14. 14. 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.
  15. 15. COMMONSYMPTOMS OF SLE  Achy joints  Fever  Fatigue  Skin Rashes
  16. 16. OTHER LUPUS SYMPTOMS Chest pain  Headache Hair loss  Dizziness Mouth sores  Depression Photosensitivity  Seizures Anemia  Memory disturbances Repeated miscarriages
  17. 17. ORGAN INVOLVEMENT WITH LUPUS Kidneys  Blood vessels Lungs  Blood Central nervous  Heart system
  18. 18. DIAGNOSING LUPUS Medical history (including family history) Complete physical examination Laboratory tests Skin or kidney biopsy
  19. 19. ACR DIAGNOSTIC CRITERIASkin criteria Systemic criteria1. Butterfly rash 5. Arthritis2. Discoid rash 6. Serositis3. Photosensitivity 7. Kidney disorder4. Oral ulcers 8. Neurologic disorder Laboratory criteria 9. Hematologic abnormalities 10. Immunologic disorder 11. Antinuclear antibody
  20. 20. Criterion Definition Malar Rash Rash over the cheeks Discoid Rash Red raised patches DIAGNOSIS resulting in the development of or increasePhotosensitivity Reaction to sunlight, 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)
  21. 21. Criterion Definition Neurologic Seizures (convulsions) and/or psychosis in the absence of Disorder drugs or metabolic disturbances which are known to cause DIAGNOSIS 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 absence Antibody of drugs known to induce it. Immunologic Positive anti-double stranded anti-DNA test, positive anti-Sm Disorder 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.
  22. 22. Malar Rash
  23. 23. Oral Ulcers
  24. 24. Systemic Lupus Erythematosus Head and Neck Manifestations  Malar rash first sign in 50%  Erythematous maculopapular eruption after sun exposure  Oral ulceration
  25. 25. Musculoskeletal System  All joints can be affected, however the wrists, knees, ankles, elbows, and shoulders are most common
  26. 26. 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
  27. 27. Cardiovascular System Pericarditis is the most common cardiac manifestation myocarditis Endocarditis with characteristic lesion of the cardiac valve
  28. 28. Pulmonary System Pleurisy is the most common manifestation of pulmonary involvement Interstitial lung disease Pulmonary embolisms
  29. 29. Gastrointestinal Sytem Difficulty swallowing Gastric reflux disease Anorexia, nausea, or vomiting may be present Pancreatitis
  30. 30. Raynaud’s Phenomena Http://www.dermis.net/doi a
  31. 31. 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
  32. 32. 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)
  33. 33. Nervous System (Cont.) Central Nerve System  Acute confusional state  Psychosis  Anxiety disorder  Headache  Cerebrovascular disease
  34. 34. Nervous System (Cont.) Peripheral Nerve System  Cranial neuropathy  Mononeuropathy  Polyneuropathy
  35. 35. COMMON LABORATORY TESTS Antinuclear Antibody (ANA) Anti DNA Anti-Sm Anti-RNP Anti-Ro Anti-La
  36. 36. OTHER LABORATORY TESTS CBC (RBC, WBC, platelets)  Rheumatoid Factor Urinalysis  Skin biopsy Sedimentation Rate (ESR)  Kidney Biopsy
  37. 37. EFFECT OF LABORATORY TESTS WITH INCREASED LUPUS ACTIVITYC reactive protein (CRP) Sedimentation rate (ESR) CBC (WBC, RBC, Anti DNA platelets) Liver and Kidney Complement Function tests Serum albumin CPK Urine protein or cell casts
  38. 38. LUPUS TREATMENT  Team effort  Tailored  Tentative
  39. 39. LUPUS PHYSICIANS  Family Practitioner  Internist  Rheumatologist  Clinical Immunologist  Dermatologist  Nephrologist  Other specialists
  40. 40. COMMONLUPUS MEDICATIONS NSAIDs Antimalarials Corticosteroids Immunosuppressants Investigational (research)
  41. 41. NSAIDs Aspirin Ibuprofen Indomethacin
  42. 42. CORTICOSTEROIDS  Prednisone  Prednisolone  Methylprednisolone  Hydrocortisone
  43. 43. ANTIMALARIALS Chloroquine
  44. 44. IMMUNE SUPPRESSANTS Cyclophosphamide Azathioprine
  45. 45. PREVENTIVE MEASURES  Sun precautions  Rest  Nutrition/diet  Exercise  Moist heat  Prevent infection  Don’t smoke
  46. 46. Th a n k Y o u

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