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