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Systemic lupus erythematosus

Definition:
  • SLE is a chronic autoimmune disease characterized by the production of autoantibodies leading to systemic inflammation affecting multiple organ systems.
Epidemiology:
  • More prevalent in women, especially during childbearing years.
  • Higher incidence and severity in African, Hispanic, and Asian populations compared to Caucasians.
Pathophysiology:
  • The exact cause is unknown, but involves a combination of genetic, environmental, and hormonal factors.
  • Autoantibody production (e.g., antinuclear antibodies – ANAs) leads to the formation of immune complexes that deposit in tissues, causing inflammation and damage.
Clinical Features:
  • Symptoms vary widely but can include:
    • General: Fatigue, fever, weight loss.
    • Skin: Malar rash (butterfly rash), discoid rash, photosensitivity.
    • Musculoskeletal: Arthralgia, arthritis.
    • Renal: Lupus nephritis.
    • Neurological: Seizures, psychosis.
    • Hematological: Anemia, leukopenia, thrombocytopenia.
    • Cardiovascular: Pericarditis, myocarditis.
  • Disease course can be characterized by periods of remissions and exacerbations.
Diagnosis:
  • Based on clinical criteria and laboratory findings.
  • ANA testing is highly sensitive but not specific.
  • Other antibodies: Anti-dsDNA, anti-Smith, anti-phospholipid antibodies.
  • Complement levels (C3, C4) can be decreased.
  • Renal biopsy may be necessary in cases of lupus nephritis.
Management:
  • No cure; treatment aims to control symptoms and prevent organ damage.
  • NSAIDs and hydroxychloroquine for mild symptoms.
  • Corticosteroids and immunosuppressants for severe organ involvement.
  • Regular monitoring for disease activity and medication side effects.
  • Multidisciplinary approach involving rheumatology, nephrology, dermatology, neurology, etc.
Prognosis:
  • Variable; modern treatments have significantly improved outcomes.
  • Important to monitor for complications such as infections, cardiovascular disease, and renal failure.

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