About Systemic Lupus

1. By Maureen Charagu
Facilitator Dr. Daniel Zuriel-Dermatopathologist
University of Nairobi
systemic lupus erythematosus by Maureen
Charagu 1

2.  History of X
 28 years female
 1 month history of
intermittent fever
 joint pains
 puffiness of her
face, hands and feet
 malar rash which
was more severe on
exposure to sunlight.
 intermittent
abdominal pain
 chest pain.
 bleeding of her
gums after
brushing her
teeth
 bruising of her
skin
systemic lupus erythematosus by Maureen Charagu 2

3.  enlarged non-tender lymph nodes and
spleen.
 A faint pericardial friction rub was present.
 Patient was on Prednisolone for treatment.
systemic lupus erythematosus by Maureen Charagu 3

4.  urine revealed moderate to severe protenuria &red and
white cells in the sediment
 serum hypoprotenemia, a reversed albumin/ globulin
ratio, hypocomplementemia, and antinuclear antibodies
(ANAs) to double stranded DNA
 CBC- low numbers platelet, neutrophil and normochromic
normocytic anaemia. LE cells were seen in a special
preparation
systemic lupus erythematosus by Maureen Charagu 4

5. systemic lupus erythematosus by Maureen Charagu 5

6.  Definition of SLE- autoimmune dx
 Causes and pathogenesis
 Morphology and Clinical Picture
 Investigations
 Treatment
6systemic lupus erythematosus by Maureen Charagu

7.  a multi-system auto-immune disease
that is caused by tissue damage
resulting from autoantibodies against
selfantigens and formation of
immunecomplexes
7systemic lupus erythematosus by Maureen Charagu

8.  Geography.
 Race.
 Sex. Affects 1 in
700 women of the
child bearing age.
 Age- high incidence 20-29 years
 Family history
 Blood group –
studies by Baart
De La Faille
systemic lupus erythematosus by Maureen Charagu 8
It’s a disease of the young and old

9. 1. Infectious agents
2. Drugs
3. UV
4. Trauma
5. Toxins and diet
6. Immune regulation
dysfunctiontolerance $
ANAs
7. Hormonal
imbalance
8. Genetic
susceptibility- HLA-DQ
locus
9systemic lupus erythematosus by Maureen Charagu

10. systemic lupus erythematosus by Maureen Charagu 10
pathogenesis
Inherited gene
$
Environmental
triggers
Nuclear
proteins, self
antigens
Activation of T$
B cells to self
antigens
IgG
autoantibody
pxn
I. Complex $
Autoantibody
mediated
tissue injury

11. Skin:
 Malar Rash
 Discoid rash
 Oral ulcers
 Photo sensitive rash
Systemic Criteria
 Arthritis
 Serositis
 Kidney Disorder
 Neurologic Disorder
 Hematolic Disorder
Laboratory Criteria
 Immunologic Disorder
systemic lupus erythematosus by Maureen Charagu 11

12. systemic lupus erythematosus by Maureen Charagu 12
photosensitivity
Oral ulcer
Bulous eruption
LE cell
a neutrophil or macrophage that has
phagocytized (engulfed) the
denatured nuclear material of
another cell

13.  Kidney WHO
Classification
 Class
I. Normal on LM
II. Mesangial lupus
GN
III. Focal
proliferative GN
IV. Diffuse
Proliferative GN
V. Mebranous GN
systemic lupus erythematosus by Maureen Charagu 13
Mesangial lupus
Slight increase in mesangial
matrix and cellularity

14. systemic lupus erythematosus by Maureen Charagu 14
Focal proliferative GN Diffuse proliferative GN Membranous GN
Entire glomerulus has hypercellularity Increased deposition of
basement membrane
Localised proliferation of the
endothelium
Characterised by hematuria and protenuria- severity depends on class

15.  Endocardial– Libmanns and sacks verrucous
vegetations on both surfaces of any of the
valves, May be superimposed with bacterial
endocarditis
 Myocarditis
 Pericardium – fibrinoid deposition with LE
bodies
systemic lupus erythematosus by Maureen Charagu 15

16. 16systemic lupus erythematosus by Maureen Charagu

17. systemic lupus erythematosus by Maureen Charagu 17
Superficial and deep perivascular
lymphocyte infiltrate
Injury to the blood vessels that
supply the retina.
Retinal hemorrhages= reduced blood
supply in:
•Macula= loss of central vision
•Optic nerve= blindness

18.  CNS- Vascular lesion= ischaemia/ multifocal
cerebral microinfarcts
 Lung- pleuritis & Pleural Effussion
 Spleen – moderately enlarged
 Lymph nodes –enlarged(edema &sinus hyperplasia) are
nontender
 Joints- synovitis
 GIT- Ulceration & arteritis (bleeding gums, Abd pain)
 Acute necritizing vasculitis
systemic lupus erythematosus by Maureen Charagu 18

19.  Screening- ANAs (antibodies to DNA,histones
etc)
 CBC (RBC, WBC, platelets)
 Urinalysis
 Sedimentation Rate (ESR)
 Rheumatoid Factor
 Skin biopsy
 Kidney Biopsy
systemic lupus erythematosus by Maureen Charagu 19

20. h C reactive protein (CRP)
h Sedimentation rate (ESR)
h Anti DNA
h Liver and Kidney
Function tests
h CPK
h Urine protein or cell
casts
i CBC (WBC, RBC,
platelets)
i Complement
i Serum albumin
20systemic lupus erythematosus by Maureen Charagu

21.  NSAIDs-ASA, ibuprofen, indomethacin
 Antimalarials-Chloroquine
 Corticosteroids-Hydrocortisone,
prednosolone, Prednisone, Methylprednisolone
 Immunosuppressants
cyclphosphamide, Azathioprine
21systemic lupus erythematosus by Maureen Charagu

22. systemic lupus erythematosus by Maureen Charagu 22
Toni Braxton
Nick Canon
Michael Jackson
Lady Gaga has borberline Lupus
People living with lupus… lets find a cure.

23. systemic lupus erythematosus by Maureen Charagu 23

24. systemic lupus erythematosus by Maureen Charagu 24