Podcast
Questions and Answers
What is a common feature of Antiphospholipid Syndrome (APS)?
What is a common feature of Antiphospholipid Syndrome (APS)?
What is the primary goal of treatment during pregnancy in APS?
What is the primary goal of treatment during pregnancy in APS?
Which of the following is a diagnostic criterion for APS?
Which of the following is a diagnostic criterion for APS?
What is the target INR for secondary prophylaxis against thrombotic events in APS?
What is the target INR for secondary prophylaxis against thrombotic events in APS?
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Which of the following is a type of thrombotic event associated with APS?
Which of the following is a type of thrombotic event associated with APS?
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What is the most common age range for the onset of Systemic Lupus Erythematosus (SLE)?
What is the most common age range for the onset of Systemic Lupus Erythematosus (SLE)?
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What is the typical duration of thrombotic events in catastrophic APS?
What is the typical duration of thrombotic events in catastrophic APS?
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Which of the following medications is used in primary prophylaxis against thrombotic events in APS?
Which of the following medications is used in primary prophylaxis against thrombotic events in APS?
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What is the characteristic of the malar rash in SLE diagnosis?
What is the characteristic of the malar rash in SLE diagnosis?
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What is the typical outcome of pregnancies in women with APS without treatment?
What is the typical outcome of pregnancies in women with APS without treatment?
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What is the primary management approach for mild to moderate SLE?
What is the primary management approach for mild to moderate SLE?
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What is the characteristic of Antiphospholipid syndrome (APS)?
What is the characteristic of Antiphospholipid syndrome (APS)?
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What is the percentage of affected individuals with SLE who are women?
What is the percentage of affected individuals with SLE who are women?
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What is the diagnostic criterion for SLE that involves the kidneys?
What is the diagnostic criterion for SLE that involves the kidneys?
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What is the medication used to control CV risk factors in SLE management?
What is the medication used to control CV risk factors in SLE management?
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What is the medication used to treat life-threatening lupus?
What is the medication used to treat life-threatening lupus?
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Study Notes
Systemic Lupus Erythematosus (SLE)
- SLE is the most common connective tissue disease.
- 90% of affected individuals are women.
- The peak age at onset is between 20 and 30 years.
- Common symptoms include fever, skin rash, arthralgia, oral ulcers, weight loss, hair loss, and Raynaud's phenomenon.
Diagnostic Criteria for SLE
- Malar rash: Fixed erythema, flat or raised, sparing the nasolabial folds.
- Discoid rash: Erythematous raised patches with adherent keratotic scarring.
- Photosensitivity: Rash due to unusual reaction to sunlight.
- Oral ulcers: Oral or nasopharyngeal ulceration, which may be painless.
- Arthritis: Non-erosive, involving two or more peripheral joints.
- Serositis: Pleuritis (pleuritic pain or rub, or pleural effusion) or pericarditis (rub, effusion).
- Renal disorder: Persistent proteinuria > 0.5 g/day or cellular casts.
- Neurological disorder: Seizures or psychosis.
- Haematological disorder: Haemolytic anaemia or leucopenia, or lymphopenia, or thrombocytopenia.
- Immunological disorder: Anti-DNA or Anti-Smith or antiphospholipid antibodies.
- Antinuclear antibody (ANA) disorder: Abnormal titre of ANA by immunofluorescence.
Management of SLE
Mild to Moderate
- Avoid exposure to sunlight and use sun block.
- Use NSAIDs.
- Use hydroxychloroquine.
- Use steroid.
- Use azathioprine or methotrexate.
- Control of CV risk factors.
Life-threatening Lupus
- Use methylprednisolone IV.
- Use cyclophosphamide IV.
- Use mycophenolate mofetil (MMF).
- Use rituximab.
- Use biologics; belimumab.
Antiphospholipid Syndrome (APS)
- Clinical syndrome presented mainly by recurrent miscarriages and recurrent arterial and venous thrombosis.
- Characterized by presence of anticardiolipin antibodies and lupus anticoagulants which target protein C or β2-glycoprotein and lead to thrombosis.
- May occur alone (primary APS) or in association with other autoimmune disease like SLE, SSc, RA.
Clinical Features of APS
- Thromboembolic events.
- Adverse pregnancy outcome.
- Venous thromboembolism.
- Arterial thromboembolism.
- Livedo reticularis.
- Skin necrosis.
- Catastrophic APS: acute vascular occlusion in 3 different organs within short time less than one week.
Diagnostic Criteria of APS
- Arterial or Venous thromboembolic events.
- Adverse pregnancy outcome (repeated abortions, premature labor, intrauterine fetal death).
- Livedo reticularis.
- Positive antiphospholipid antibodies (lupus anticoagulants, anticardiolipin antibodies, anti-beta2 glycoprotein) at least 3 months apart.
Treatment of APS
Primary Prophylaxis against Thrombotic Events
- Use aspirin.
- Use statins.
- Use hydroxychloroquine.
- Use vitamin K antagonists (Warfarin).
Secondary Prophylaxis against Thrombotic Events
- Use vitamin K antagonists (Warfarin).
- The desired INR target: ≥ 2.
- Use direct oral anticoagulants (DOAC): ±.
During Pregnancy
- Treatment aims to improve the pregnancy outcome.
- Use aspirin + heparin.
- Use aspirin + low molecular weight heparin (LMWH).
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Description
A short quiz about Systemic Lupus Erythematosus (SLE), a connective tissue disease, its demographics, and symptoms. Part of the Introduction to Clinical Immunology course.
