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SLE
             BY
DR. EHAB ELTORABY
     MD GENERAL MEDICINE
RHEUMATOLOGY &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 d...
Definition (Cont.)
   The immune system loses the ability to
    differentiate between foreign cells and
    it’s own cel...
INCIDENCE OF LUPUS

   Between 500,000 to 1.5 million
    Americans have lupus.
   80-90% of lupus patients are female.
...
WHAT CAUSES LUPUS?


 Genetics   Hormones


     Environment
Etiology
   The specific cause is unknown
   Genetic factors may play a role
   Environmental agents
   Drugs or other...
LUPUS IS…

   Different for each person.
   A disease that ranges from mild to life
    threatening.
   Characterized b...
TYPES OF LUPUS

   Discoid or Cutaneous Lupus (DLE)
   Drug Induced Lupus (DIL)
   Neonatal Lupus
   Systemic Lupus Er...
DISCOID LUPUS
   Affects the skin, hair or mucous
    membranes.
   Identified by a rash or lesions.
   Diagnosed by bi...
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, h...
SYSTEMIC LUPUS
       ERYTHEMATOSUS
   Can affect any organ in the body
    including the joints, skin, lungs, heart,
   ...
COMMON
SYMPTOMS OF SLE
    Achy joints
    Fever
    Fatigue
    Skin Rashes
OTHER
            LUPUS SYMPTOMS
    Chest pain                Headache
    Hair loss                 Dizziness
    M...
ORGAN INVOLVEMENT
       WITH LUPUS

   Kidneys              Blood vessels
   Lungs                Blood
   Central n...
DIAGNOSING LUPUS

   Medical history (including family history)
   Complete physical examination
   Laboratory tests
 ...
ACR DIAGNOSTIC CRITERIA
Skin criteria             Systemic criteria
1.   Butterfly rash       5.   Arthritis
2.   Discoid ...
Criterion                                      Definition
    Malar Rash     Rash over the cheeks

  Discoid Rash     Red ...
Criterion                                                    Definition
   Neurologic      Seizures (convulsions) and/or p...
Malar Rash
Oral Ulcers
Systemic Lupus Erythematosus

   Head and Neck Manifestations
     Malar rash first sign in 50%
     Erythematous macul...
Musculoskeletal System

    All joints can be affected,
     however the wrists, knees,
     ankles, elbows, and shoulder...
Musculoskeletal System
(Cont.)
    Hand deformities can include ulnar
     deviation and subluxation, swan neck
     defo...
Cardiovascular System

 Pericarditis is the most
  common cardiac
  manifestation
 myocarditis

 Endocarditis with

  c...
Pulmonary System

   Pleurisy is the most common
    manifestation of pulmonary
    involvement
   Interstitial lung dis...
Gastrointestinal Sytem
   Difficulty swallowing
   Gastric reflux disease
   Anorexia, nausea, or vomiting may be prese...
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
    abnormalitie...
Nervous System
   Neuropsychiatric manifestations of
    lupus occur frequently
       May be mild to severe
       Any...
Nervous System (Cont.)
   Central Nerve System
      Acute confusional

       state
      Psychosis

      Anxiety di...
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)    ...
LUPUS TREATMENT


    Team effort
    Tailored
    Tentative
LUPUS PHYSICIANS
    Family Practitioner
    Internist
    Rheumatologist
    Clinical Immunologist
    Dermatologist...
COMMON
LUPUS MEDICATIONS
   NSAIDs
   Antimalarials
   Corticosteroids
   Immunosuppressants
   Investigational (rese...
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
      Prev...
Th a n k Y o u
SLE
SLE
SLE
SLE
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SLE

  1. 1. SLE BY DR. EHAB ELTORABY MD GENERAL MEDICINE RHEUMATOLOGY &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. COMMON SYMPTOMS 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 CRITERIA Skin criteria Systemic criteria 1. Butterfly rash 5. Arthritis 2. Discoid rash 6. Serositis 3. Photosensitivity 7. Kidney disorder 4. 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 increase Photosensitivity 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. COMMON LUPUS 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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