Systemic Lupus Erythematosus

SYSTEMIC LUPUS

ERYTHEMATOSUS

By:Izatty Lim0308188

Basic pathogenesis

Clinical featuresInvestigation

SLE

Multisystem auto-immune disorder

Formation of autoantibodies o antinuclear antibodies/ANAso Lead to inflammation and abnormal blood vessels (vasculitis,

immune complex deposition)

Clinically,o Chronico Unpredictableo Remitting & relapsing diseaseo Insidious onseto Many clinical presentation overlap features of other

autoimmune disease.

BASIC PATHOGENESIS

CLINICAL FEATURES

Common in women

CLINICAL FEATURES Dermatologic

o Cutaneous vascular lesiono Butterfly rasho Oral ulcerso Alopeciao Photosensitivity

Musculoskeletalo Arthritis (non-erosive) o Characterized by

tenderness, swelling or effusion.

CLINICAL FEATURES

Cardiopulmonaryo Pleuritis, pericaditis o Libman-Sack endocarditis (less

common)o Coronary artery disease o Interstitial fibrosis (lung)

Renalo Proteinuriao Glomerulonephritis (deposition

of DNA-anti-DNA complexes within glomeruli)

o Renal failure

CLINICAL FEATURES Nervous system

o Often ascribed it is due to vascular lesion

o Cerebral microinfarctso Seizure, psychosis

Hematologico Hemolytic anemia o Leukopeniao Lymphopeniao Thrombocytopenia

INVESTIGATION FANA

o Anti-dsDNA and anti-Sm antibody

Homogeneous pattern: o found with antibodies to chromatin, histones &

double stranded DNA. o seen in lupus and occasionally in other

autoimmune diseases. Speckled pattern:

o found with antibodies to non-DNA nuclear antigens.

o most common immunofluorescent pattern & least specific

Nucleolar pattern (green spots): o found with antibodies to RNA. o systemic sclerosis

Rim or peripheral pattern: o found with antibodies to double-stranded DNA.

This pattern is seen frequently in lupus.

INVESTIGATION ELISA Test

o ds-DNA antibodieso Anti-histone antibodieso Deoxyribonucleoprotein

(DNP)

Ouchterlony Testo Used to determine immunological specificityo Shows the serum does or does not have antinuclear antibodies

Multiplexed immunoassayso support the identification of

multiple autoantibodies from a single determination in the same time.

INVESTIGATION

 established by the American Rheumatism Association

INVESTIGATION CBC with differential Serum creatinine Urinalysis with microscopy ESR or CRP results Complement levels Liver function tests (Alanine aminotransferase

(ALT)) Creatine kinase assay (myocarditis, myocardial

infarction) Spot protein/spot creatinine ratio (proteinuria) Autoantibody tests

REFERANCES Robbins Basic Pathology 9th Edition

• By Kumar Abbas Aster

Journal of Clinical Pathologyo http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769989/

Pathology Student. FANA Testing.o http://www.pathologystudent.com/?p=7612

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