Systemic lupus erythematosus
Description
- Multisystem autoimmune disease: autoantibodies to nuclear antigens -> immune complex deposition + complement consumption
- Relapsing-remitting, any organ, protean
Lupus-spectrum entities
- SLE - systemic
- Cutaneous lupus - may be isolated or part of SLE
- Acute (ACLE) - malar/butterfly rash (spares nasolabial folds), or generalised photosensitive erythema. Tracks disease activity
- Subacute (SCLE) - annular/psoriasiform, photodistributed, anti-Ro. Non-scarring. Drug-induced in ~1/3 (terbinafine, thiazides, PPIs, TNFi)
- Chronic/discoid (CCLE) - scarring, follicular plugging, dyspigmentation, scarring alopecia. Commonest chronic form. Only ~5% progress to SLE
- Drug-induced lupus - arthralgia + serositis dominant, renal and CNS disease rare, resolves on withdrawal
- Neonatal lupus - maternal anti-Ro/La transplacental -> rash, cytopenias, congenital heart block (irreversible, ~2% of anti-Ro mothers)
- Antiphospholipid syndrome - ~30% of SLE have aPL, ~15% develop APS
Organ involvement (approx frequency)
- Constitutional 90%, musculoskeletal 90%, mucocutaneous 80%, haematological 70%
- Renal 40-50%, neuropsychiatric 20-40%, serositis 30%, cardiac 15%
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