Systemic lupus erythematosus
Presented by:
Rajashree K S
2nd year M.Sc.
BC120124 Guided by:
DOS in Biochemistry Dr.GV Rudresh
University of Mysore
DOS in Biochemistry
University of Mysore
INTRODUCTION
• Lupus is a Latin word for wolf. Erythematosus means red rashes.
• In 1851, Dr Cazenave discovered red rashes on patients face that looked
like wolf bites. He named the rash - Discoid lupus erythematosus
• In 1885, Sir William Osler recognized that many people with lupus had a
disease involving not only skin, but many other organs or systems.
He named the disease – SYSTEMIC LUPUS ERYTHEMATOSUS
SLE is a complex multisystem autoimmune disorder where the immune
cells loses the ability to differentiate between foreign cells and its own cells
and tissues followed by formation of autoantibodies and inflammation
Etiology of SLE is unknown and its clinical features are highly variable
EPIDEMIOLOGY
Incidence: 4 to 7 new cases/100,000 cases per year
Prevalence: 1: 2000 population
Female: Male ratio: 9:1( in adults)
as low as 2:1 ( in prepubertal children)
• Age: 80% cases in females during childbearing years(20-45)
[ SLE can occur in all age group, but it is uncommon before 8 years of
age]
Race: more common in blacks and Asians than in whites
PATHOPHYSIOLOGY
ETIOLOGY
•Exact etiology of SLE is unknown
•Yet, SLE is multifactorial
Genetic factors
Environmental factors
Immunological factors
Endocrine factors
Infections
Clinical manifestations
CLINICAL FEATURES OF SLE
• Constitutional symptoms
• Mucocutaneous involvement
• Musculoskeletal manifestations
• Hematological manifestations
• Renal disease
• Neuropsychiatric manifestation
• pulmonary manifestation
• Cardiovascular manifestations
• Gastrointestinal involvement
MUCOCUTANEOUS SYMPTOMS
Malar rash Discoid rash Photosensitivity
Vasculitis Nail involvement Alopecia Oral ulcers
MUSCULOSKELETAL MANIFESTATION
Fibromyalgia
Lupus arthritis
HEMATOLOGICAL
MANIFESTATIONS
Anemia leukopenia
splenomegaly
Inflammatory myopathy
Thrombocytopenia
RENAL MANIFESTATION PULMONARY
MANIFESTATION
Pleuritis is most common
• Exudative pleural effusion
• Acute lupus
• Non specific interstitial
pneumonia
• Alveolar hemorrhage
Lupus nephritis Red cell casts • Pulmonary arterial
hypertension
• Shrinking lung syndrome
• Pleural effusion
• Pneumonitis
• Thromboembolic disease
Haematuria Proteinuria
CARDIOVASCULAR MANIFESTATIONS
• Pericarditis
• Myocarditis
.
• Endocarditis
• Mitral valve lesions
Atherosclerosis
• Congestive heart failure
• Arrhythmias Libman-sacks
endocarditis
• Atherosclerosis
• Libman -sacks endocarditis
• Valvular disease
• cardiomyopathy
Cardiomyopathy
DIAGNOSIS
1.BLOOD TEST 2.IMAGING TEST
Complete blood count: X-ray
C –Reactive protein(CRP): ECG
Activated partial thromboplastin CT scan
time (aPTT) MRI
Erthyrocyte sedimentation Ultrasound
rate(ESR): BMD
LE cell:
Compliment levels:
Creatinine kinase assay
Urinalysis
3.Test for Autoantibodies
American college of Rheumatology(ACR):
Criteria for diagnosis of SLE
TREATMENT
Inflammation, pain, fever
B-cell survival and T-cell, cytokines
development NSAIDs (multiple)
Monoclonal
antibodies Anti-malarials
(belimumab) (HCQ)
Immuno- Cortico-steroids
T- and B-cells suppressants Inflammation
(CYC, AZA, MMF)
(prednisone)
Maidhof W, et al. P T. 2012 Apr; 37(4): 240-246.
THANKTHANK
YOU YOU