Systemic lupus erythematosus

1. SYSTEMIC LUPUS
ERYTHEMATOSUS

2. Systemic lupus erythematosus
(SLE)
■ a chronic autoimmune inflammatory disease
■ More in women
■ Systemic : affecting many organs and systems, 90 % with joints and skin .

3. Diagnosis
■ The most specific antibody for the diagnosis is dsDNA antibody
■ ACR criteria helps in the diagnosis

4. ■ The diagnosis if 4 or more criteria of the following :

5. COURSE OF THE DISEASE
■ Flares and remissions
■ Flares increased with pregnancy ( late in pregnancy ) and may mimic
PET
■ risks of miscarriage, fetal death, pre-eclampsia, preterm delivery
and FGR
■ More complications if lupus nephritis , HTN or APS antibodies present

6. flares of SLE
■ SLE flare may mimic PET by presence of HTN , Proteinuria , renal
impairment and low platelets in both disorders
■ SLE flare can be differentiated from PREECLAMPSIA by :
• Rising anti-DNA titre.
• Fall in complement levels.
• No increase in serum uric acid.
• No abnormal liver function.

7. NEONATAL LUPUS
■ 30% of mothers with SLE also have anti-Ro/La antibodies, which cross the
placenta and can cause the clinical syndromes neonatal lupus and
congenital heart block.
■ The risk of neonatal lupus is around 5
■ cutaneous lesions 2–3 weeks after birth, disappearing spontaneously
without scarring within 6 months

8. In utero heart block
■ The risk of congenital heart block is around 2%
■ It appears in utero, is detected at 18–20 weeks
■ permanent and difficult to treat
■ associated with a 20% perinatal mortality.
■ Of those who survive, over 50% need pacemakers in early
infancy.

9. ANTIPHOSPHOLIPID SYNDROME
■ Syndrome = presence of symptoms or event + autoantibodies
■ May present alone or with SLE
■ Risk of miscarriage , fetal death ,VTE , preeclampsia , IUGR

10. ANTIPHOSPHOLIPID SYNDROME
■ Diagnosed by Sapporo criteria
■ Importantly, a diagnosis of APS requires that the positive antibody titres must be present
on two occasions, 3 months apart.

11. Management in pregnancy (SLE and
APS )
■ Low dose aspirin (risk of PET )
■ LMWH +aspirin if APS with previous VTE event or repeated pregnancy
loss
■ In SLE: steroids, azathioprine, sulfasalazine and
hydroxychloroquine are safe and NSAIDs can be given until week
32 of pregnancy
■ Baseline renal function test