Presentations
- Arthralgia
- Chest pain
- Fatigue
- Fever
- Haemolysis
- Lymphadenopathy
- Oedema
- Pleural / Pericardial effusion
- Proteinuria
- Rash
- Raynaud phenomenon
- Shortness of breath
- Ulcers
Conditions
- Antiphospholipid syndrome
- Cutaneous lupus
- Sjögren syndrome
- Systemic lupus erythematosus (SLE):
- lupus nephritis – types I–V
- mixed connective tissue disease
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigation
- consider the impact of illness and disease on patients and families, and their quality of life
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Complete heart block – fetus / neonate
- Neurological or neuropsychiatric symptoms
- Secondary hemophagocytic lymphohistiocytosis (HLH)
- Sicca symptoms
Conditions
- Drug-related lupus
- Kikuchi–Fujimoto disease
- Neonatal lupus
- Undifferentiated connective tissue disease
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigation
- consider the impact of illness and disease on patients and families, and their quality of life
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Epidemiology
- Difference between ethnic groups, with particular reference to Aboriginal and Torres Strait Islander peoples and Māori
- Incidence and prevalence
- Male to female ratio, highlighting the female predominance in autoimmune disease
Pathophysiology
- Potential genetic and environmental triggers in the pathophysiology of SLE
Pharmacological treatment strategies in SLE
- Drug interactions, induction versus maintenance therapy, safety monitoring, and side effect profiles for medications:
- anticoagulant drugs
- antimalarial – hydroxychloroquine
- corticosteroids
- cytotoxic drugs, such as cyclophosphamide
- disease-modifying antirheumatic drugs (DMARDs), including:
- biological DMARDs (bDMARDs):
- B cell targeting therapies
- interferon-targeting
- conventional DMARDs (cDMARDs)
- non-steroidal anti-inflammatory drugs
- other treatment strategies:
- antihypertensive agents
- anti-infective prophylaxis
- lipid-lowering agents
- treatment strategies for Raynaud syndrome:
- non-pharmacological measures
- pharmacological measures
Clinical assessment
- Diagnostic and classification criteria
- Disease activity measures
- Disease damage measures
Imaging and other investigations
- Autoantibodies:
- antinuclear antibodies (ANA)
- antiphospholipid antibodies:
- anticardiolipin
- anti-B2-glycoprotien I
- lupus anticoagulant
- antithyroid antibodies
- anti-C1q antibodies
- anti-double-stranded DNA (dsDNA)
- anti-histone antibodies
- extractable nuclear antibodies, such as:
- rheumatoid factor (RhF)
- Biochemical analysis:
- complement studies:
- creatinine
- electrolytes
- ferritin
- immunoglobulins:
- liver function tests
- muscle enzymes:
- thyroid function tests
- urea
- Haematological markers:
- clotting studies, including lupus anti-coagulant
- complete blood count
- Coombs test
- Imaging:
- angiography:
- CT
- echocardiography
- MRI
- PET
- radionucleotide studies
- ultrasound
- x-ray
- Inflammatory markers:
- C-reactive protein (CRP)
- erythrocyte sedimentation rate (ESR)
- Kidney histopathology result interpretation
- Lung function testing
- Macrophage activation syndrome testing
- Pre-immunosuppression screening
- Urinalysis:
- B2-microglobulin
- protein and albumin – creatinine ratio
- spun urine microscopy
- urine ratios
Procedures
- Consideration of biopsy of specific organs, such as:
Outcomes and long-term monitoring in SLE
- Cardiovascular outcomes in SLE
- Differences between adult- and childhood-onset SLE
- Mortality rates
- Other organ-specific outcomes:
- central nervous system (CNS)
- eyes
- kidney
- lung
- skin
- Potential triggers of flare
- Role of dsDNA, complement, and inflammatory markers in monitoring disease activity
