sle: etio, patho, mani, tx, dx

Etiology of SLE

➢ Unknown

➢ Interrelated immunologic, environmental, genetic

➢ Primary causative mechanism: immune dysregulation in the form of autoimmunity

➢ Mental stress

➢ Low dose estrogen contraceptives

Pathogenesis of SLE

➢ 3 main mechanism in development of lupus

➢ autoantibodies – body produces Ab against its own cell and Ag

➢ vascular abnormality

➢ inflammatory mediators

➢ Deposition of Ag-Ab complex at various tissue site suppressing body’s normal immunity

DIAGNOSIS

The information below is according from what?

➢ At least 1 clinical or 1 immunologic criteria or biopsy proven lupus nephritis ( presence of ANA or antidouble stranded DNA Ab)

➢ American College of Rheumatology:

DIAGNOSIS

CLINICAL OR IMMUNOLOGIC CRITERIA?

➢ Acute or chronic lupus

➢ Oral ulcers

➢ Non-scarring alopecia

➢ Synovitis > 2 joints of at least 30 mins morning stiffness

➢ Renal involvement

➢ Neurologic manifestations

➢ CLINICAL CRITERIA

DIAGNOSIS

CLINICAL OR IMMUNOLOGIC CRITERIA?

➢ Acute or chronic lupus

➢ CLINICAL CRITERIA

DIAGNOSIS

CLINICAL OR IMMUNOLOGIC CRITERIA?

➢ Oral ulcers

➢ CLINICAL CRITERIA

DIAGNOSIS

CLINICAL OR IMMUNOLOGIC CRITERIA?

➢ Non-scarring alopecia

➢ CLINICAL CRITERIA

DIAGNOSIS

CLINICAL OR IMMUNOLOGIC CRITERIA?

➢ Synovitis > 2 joints of at least 30 mins morning stiffness

➢ CLINICAL CRITERIA

DIAGNOSIS

CLINICAL OR IMMUNOLOGIC CRITERIA?

➢ Renal involvement

➢ CLINICAL CRITERIA

DIAGNOSIS

CLINICAL OR IMMUNOLOGIC CRITERIA?

➢ ANA level

➢ Anti-double stranded DNA Ab

➢ anti-Sm

➢ Anti-phospholipid antibody

➢ Low complement

IMMUNOLOGIC CRITERIA

DIAGNOSIS

CLINICAL OR IMMUNOLOGIC CRITERIA?

➢ ANA level

IMMUNOLOGIC CRITERIA

DIAGNOSIS

CLINICAL OR IMMUNOLOGIC CRITERIA?

➢ Anti-double stranded DNA Ab

IMMUNOLOGIC CRITERIA

DIAGNOSIS

CLINICAL OR IMMUNOLOGIC CRITERIA?

➢ anti-Sm

IMMUNOLOGIC CRITERIA

DIAGNOSIS

CLINICAL OR IMMUNOLOGIC CRITERIA?

➢ Anti-phospholipid antibody

IMMUNOLOGIC CRITERIA

DIAGNOSIS

CLINICAL OR IMMUNOLOGIC CRITERIA?

➢ Low complement

IMMUNOLOGIC CRITERIA

TREATMENT

• Objective: to ____ the disease, ____ damage, prevent flare-ups

• ____ symptoms

  • ____ relieve muscle pain

• ____ sparing treatment (methotrexate to preserve bone and protection of premature CV disease)

• anti-coagulants

• Anti _____ agents (chloroquine) useful against dermatological, renal and arthritic symptoms

• Immunomodulating drugs:

  • ______, ______

  • To suppress _____ and used for active diseases

TREATMENT

• Objective: to control the disease, prevent damage, prevent flare-ups

• Mild symptoms

  • NSAIDS relieve muscle pain

• Corticosteroid sparing treatment (methotrexate to preserve bone and protection of premature CV disease)

• anti-coagulants

• Anti malarial agents (chloroquine) useful against dermatological, renal and arthritic symptoms

• Immunomodulating drugs:

  • Azathioprine, cyclophosphamide

  • To suppress inflammation and used for active diseases