Rawalpindi Medical college

1. SYSTEMIC LUPUS
ERYTHEMATOSUS
Dr Nadim Iqbal Sheikh
Assoc. Prof. Medicine
Rawalpindi General Hospital

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. 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. Drugs Causing SLE
–
–
–
–
–
–
Hydralazine
Procainamaide
Quinidine
Phenytoin
Isoniazid
chlorpromazine

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. 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. ARA Criteria for Dx of
SLE

Criteria
%
– Malar rash
– Discoid Rash
62
– Photosensitivity
16
22
86
– Oral/nasal ulcers
– Non-deforming arthritis
30

8. 
Criteria
–
–
–
–
–
Renal Disease
Neurological disease
(psychosis/seizures)
Haem(↓Hb,WBC,Platelets
Serositis
 (pleurisy/percarditis)
ARA Revised Criteria 1982
%
24
19
50
30

11. 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

12. 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

13. 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

14. 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)

15. UPDATE




Fully active, going to college
Steroids withdrawn
Dose of azathioprine increased
Eye surgery with placement of artificial
eye done.

16. THANK YOU