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home - Miscellaneous - Rheumatological Disease - SLE Written by Dr Sebastian Zeki

SLE

GI manifestations of SLEGI manifestations occur in 30 % Peptic Ulcer DiseasePeptic ulcers occur in 15 % (due to NSAIDS or SLE).PUD usually doesnt result in bleed-ing or perforation. Mesenteric vasculitis and infarction:This is associated with peripheral vasculitis and CNS lupus.Perforation is associated with severe active lupus.Treatment involves steroids + cyclo-phosphamide.Surgery is indicated if there is no response/ perforation. Protein Losing enteropathyThis is rare in SLE.It occurs in young women.It is confirmed with 24 hour alpha 1 antitrypsin studies. a)Prominence of mesenteric vessels b)Palisading pattern or comb-like appearance supplying dilated bowel loops c)Other findings included ascites and small bowel thickening. CT Abdomen findings: 15% 6% Liver DiseaseHepatomegaly is present in 50 %.Jaundice is rare- usually haemolysis.Commonly have LFT abnormalities, but cirrhosis is rare. PancreatitisThis is associated with active SLE else-where.Patients can get raised amylase and remain asymptomatic.Pancreatitis due to lupus may result from vasculitis or thrombosis (in asso-ciation with antiphospholipid antibod-ies).Treatment is as per normal pancreatitis.If there is no obvious cause and the patient has active lupus, can give steroids.It has been shown that there is a reduced mortality for patients on azathioprine and steroids, so they can be continued unless obviously related/ other cause other than lupus found. Dysphagia This is due to oesophageal hypomotility (inflammed muscles/ischemic or vasc-litic changes to Auerbach's plexus).It is associated with the Raynaud’s and anti-ribonucleoprotein antibodies. ArteriographyVasculitis generally involves small arteries, which can lead to a -ve arteriogram Causes:SLE, NSAIDS, coincidental diseaseLupoid hepatitis (=autoimmune hepatitis) NOT LUPUS HEPATITISANA positive in bothSMA and AMA rare in lupus; thus, suggests autoimmune hepatitis.Antiribosomal P protein antibodies with -ve AMA and SMA suggests lupus hepatitis. Written by Dr Sebastian Zeki

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