{"id":36947,"date":"2026-06-06T07:49:47","date_gmt":"2026-06-06T02:19:47","guid":{"rendered":"https:\/\/atsixty.com\/?p=36947"},"modified":"2026-06-06T07:50:40","modified_gmt":"2026-06-06T02:20:40","slug":"sle-antiphospholipid-syndrome","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/neet-pg\/sle-antiphospholipid-syndrome\/","title":{"rendered":"SLE &amp; Antiphospholipid Syndrome"},"content":{"rendered":"\n<meta charset=\"UTF-8\">\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\">\n<title>Morning Rounds \u00b7 SLE &amp; Antiphospholipid Syndrome<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&#038;family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&#038;display=swap\" rel=\"stylesheet\">\n<style>\n#rhmq02 *,#rhmq02 *::before,#rhmq02 *::after{box-sizing:border-box;margin:0;padding:0}\n#rhmq02{\n  --ter:#8B3D20;\n  --ter-light:#B85A38;\n  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y=\"0\" width=\"170\" height=\"200\" rx=\"8\" fill=\"#0d0d1f\"\/>\n      <rect x=\"185\" y=\"0\" width=\"170\" height=\"200\" rx=\"8\" fill=\"#0d0d1f\"\/>\n      <rect x=\"370\" y=\"0\" width=\"170\" height=\"200\" rx=\"8\" fill=\"#0d0d1f\"\/>\n      <!-- Labels -->\n      <text x=\"85\" y=\"16\" text-anchor=\"middle\" fill=\"#aaaaaa\" font-size=\"9\" font-family=\"Georgia,serif\">Homogeneous<\/text>\n      <text x=\"270\" y=\"16\" text-anchor=\"middle\" fill=\"#aaaaaa\" font-size=\"9\" font-family=\"Georgia,serif\">Speckled<\/text>\n      <text x=\"455\" y=\"16\" text-anchor=\"middle\" fill=\"#aaaaaa\" font-size=\"9\" font-family=\"Georgia,serif\">Nucleolar<\/text>\n      <!-- Homogeneous: filled nucleus -->\n      <ellipse cx=\"85\" cy=\"100\" rx=\"52\" ry=\"62\" fill=\"#3a6ecc\" opacity=\"0.75\"\/>\n      <ellipse cx=\"85\" cy=\"100\" rx=\"52\" ry=\"62\" fill=\"none\" stroke=\"#6090e8\" stroke-width=\"1.5\"\/>\n      <!-- Speckled: dots across nucleus -->\n      <ellipse cx=\"270\" cy=\"100\" rx=\"52\" ry=\"62\" fill=\"none\" stroke=\"#6090e8\" stroke-width=\"1.5\"\/>\n      <circle cx=\"252\" cy=\"82\" r=\"4\" fill=\"#c8e040\" opacity=\"0.9\"\/>\n      <circle cx=\"275\" cy=\"72\" r=\"3.5\" fill=\"#c8e040\" opacity=\"0.85\"\/>\n      <circle cx=\"292\" cy=\"88\" r=\"4\" fill=\"#c8e040\" opacity=\"0.9\"\/>\n      <circle cx=\"258\" cy=\"104\" r=\"3\" fill=\"#c8e040\" opacity=\"0.8\"\/>\n      <circle cx=\"280\" cy=\"110\" r=\"4.5\" fill=\"#c8e040\" opacity=\"0.9\"\/>\n      <circle cx=\"262\" cy=\"122\" r=\"3.5\" fill=\"#c8e040\" opacity=\"0.85\"\/>\n      <circle cx=\"288\" cy=\"118\" r=\"3\" fill=\"#c8e040\" opacity=\"0.8\"\/>\n      <circle cx=\"248\" cy=\"116\" r=\"3\" fill=\"#c8e040\" opacity=\"0.75\"\/>\n      <!-- Nucleolar: bright nucleolus only -->\n      <ellipse cx=\"455\" cy=\"100\" rx=\"52\" ry=\"62\" fill=\"none\" stroke=\"#6090e8\" stroke-width=\"1.5\"\/>\n      <ellipse cx=\"455\" cy=\"98\" rx=\"18\" ry=\"14\" fill=\"#e87040\" opacity=\"0.9\"\/>\n      <!-- Antibody labels below -->\n      <text x=\"85\" y=\"182\" text-anchor=\"middle\" fill=\"#8888cc\" font-size=\"8\" font-family=\"Georgia,serif\" font-style=\"italic\">anti-dsDNA \/ anti-histone<\/text>\n      <text x=\"270\" y=\"182\" text-anchor=\"middle\" fill=\"#8888cc\" font-size=\"8\" font-family=\"Georgia,serif\" font-style=\"italic\">anti-Sm \/ anti-SSA \/ anti-SSB<\/text>\n      <text x=\"455\" y=\"182\" text-anchor=\"middle\" fill=\"#8888cc\" font-size=\"8\" font-family=\"Georgia,serif\" font-style=\"italic\">anti-Scl-70 \/ anti-RNA pol III<\/text>\n    <\/svg>\n    <figcaption>\n      ANA immunofluorescence patterns. <strong>Homogeneous<\/strong>: diffuse nuclear staining \u2014 anti-dsDNA (SLE-specific) and anti-histone (drug-induced lupus). <strong>Speckled<\/strong>: anti-Sm (SLE-specific), anti-SSA\/SSB (Sjogren's, neonatal lupus), anti-RNP (MCTD). <strong>Nucleolar<\/strong>: anti-Scl-70 and anti-RNA polymerase III \u2014 systemic sclerosis.\n    <\/figcaption>\n  <\/figure>\n<\/div>\n\n<div id=\"rhmq02\">\n\n  <div class=\"mr-header\">\n    <div class=\"mr-eyebrow\">Morning Rounds \u00b7 Rheumatology Series \u00b7 Round 02<\/div>\n    <div class=\"mr-title\">\n      SLE &amp; Antiphospholipid Syndrome<br><em>Clinical Reasoning<\/em>\n    <\/div>\n    <div class=\"mr-subtitle\">Five cases &middot; Read carefully &middot; Trust your instinct<\/div>\n    <div class=\"mr-chips\">\n      <span class=\"mr-chip\">5 Cases<\/span>\n      <span class=\"mr-chip\">+4 \/ &minus;1 scoring<\/span>\n      <span class=\"mr-chip\">Options reshuffled<\/span>\n    <\/div>\n  <\/div>\n\n  <div class=\"mr-sentinel\" id=\"rhmq02-sentinel\"><\/div>\n\n  <div class=\"mr-progress\" id=\"rhmq02-progress\">\n    <div class=\"mr-prog-inner\">\n      <div class=\"mr-pips\" id=\"rhmq02-pips\"><\/div>\n    <\/div>\n  <\/div>\n\n  <div class=\"mr-body\">\n    <div id=\"rhmq02-cases\"><\/div>\n    <div class=\"mr-submit-wrap\">\n      <button class=\"mr-btn\" id=\"rhmq02-submit\">Submit for Debrief<\/button>\n    <\/div>\n    <div class=\"mr-score\" id=\"rhmq02-score\">\n      <div class=\"mr-score-in\">\n        <div class=\"mr-score-ey\">Round Complete<\/div>\n        <div class=\"mr-ring\" id=\"rhmq02-ring\">\n          <div class=\"mr-ring-in\">\n            <span class=\"mr-ring-pct\" id=\"rhmq02-pct\">0%<\/span>\n            <span class=\"mr-ring-sub\">net<\/span>\n          <\/div>\n        <\/div>\n        <div class=\"mr-score-title\">Your Debrief<\/div>\n        <div class=\"mr-score-net\" id=\"rhmq02-net\"><\/div>\n        <div class=\"mr-verdict\" id=\"rhmq02-verdict\"><\/div>\n        <div class=\"mr-bands\">\n          <span class=\"mr-band mr-band-c\" id=\"rhmq02-ct-c\"><\/span>\n          <span class=\"mr-band mr-band-w\" id=\"rhmq02-ct-w\"><\/span>\n          <span class=\"mr-band mr-band-s\" id=\"rhmq02-ct-s\"><\/span>\n        <\/div>\n        <button class=\"mr-retry\" id=\"rhmq02-retry\">&#8635; New Round<\/button>\n      <\/div>\n    <\/div>\n  <\/div>\n\n<\/div><!-- end #rhmq02 -->\n\n<script>\n(function () {\n  'use strict';\n\n  var NS    = 'rhmq02';\n  var TOTAL = 5;\n  var MAX   = 20;\n  var LTRS  = ['A','B','C','D'];\n\n  var QS = [\n\n    {\n      id:      1,\n      tag:     'SLE &mdash; ANA Patterns',\n      stem:    'A <strong>24-year-old woman<\/strong> presents with a malar rash, oral ulcers, and arthritis of the small joints of both hands. ANA titre is 1:640 with a <strong>homogeneous pattern<\/strong>. Which antibody combination is <em>most specific<\/em> for SLE and is most likely to be positive here?',\n      correct: 'Anti-dsDNA and anti-Sm',\n      opts: [\n        'Anti-dsDNA and anti-Sm',\n        'Anti-SSA (Ro) and anti-SSB (La)',\n        'Anti-histone and anti-dsDNA',\n        'Anti-RNP and anti-Sm'\n      ],\n      exp:     '<strong>Anti-dsDNA<\/strong> and <strong>anti-Sm<\/strong> are the two antibodies with the highest specificity for SLE (&gt;95% each) and are included in the SLICC and ACR\/EULAR 2019 classification criteria. A homogeneous ANA pattern reflects antibodies against chromatin and dsDNA. Anti-SSA\/SSB are seen in SLE but are more characteristic of <em>Sjogren\\'s syndrome<\/em>; anti-histone is the hallmark of <strong>drug-induced lupus<\/strong>. Anti-RNP in high titre defines <strong>MCTD<\/strong>.',\n      imgId:   'rhmq02-img1'\n    },\n\n    {\n      id:      2,\n      tag:     'SLE &mdash; ACR\/EULAR 2019 Criteria',\n      stem:    'A <strong>29-year-old woman<\/strong> has a positive ANA (entry criterion met). She has thrombocytopaenia (platelets 88 &times; 10&#x2079;\/L), haemolytic anaemia with a positive direct Coombs test, pleuritis on CT, and a malar rash. Anti-dsDNA is positive. Using the <strong>2019 ACR\/EULAR classification criteria<\/strong>, what is her total score and does she meet the threshold?',\n      correct: 'Score &ge;10; threshold met &mdash; she classifies as SLE',\n      opts: [\n        'Score &ge;10; threshold met &mdash; she classifies as SLE',\n        'Score 8; threshold not met &mdash; further criteria required',\n        'Score &ge;10 but anti-dsDNA positivity alone is insufficient without renal involvement',\n        'The 2019 criteria require biopsy-proven organ damage before classification'\n      ],\n      exp:     'The <strong>2019 ACR\/EULAR criteria<\/strong> require a positive ANA as entry criterion, then assign weighted scores across seven domains. Malar rash (6), pleuritis (5), thrombocytopaenia (4), haemolytic anaemia (4), and anti-dsDNA (6) together far exceed the <strong>threshold of 10<\/strong>. Renal biopsy is not required for classification. Each domain contributes only its highest-scoring item; this patient scores well above threshold across constitutional, haematological, serosal, and immunological domains.',\n      imgId:   null\n    },\n\n    {\n      id:      3,\n      tag:     'Drug-Induced Lupus',\n      stem:    'A <strong>58-year-old man<\/strong> on <strong>hydralazine<\/strong> for hypertension for three years develops arthralgia, pleuritis, and a positive ANA with <strong>anti-histone antibodies<\/strong>. Anti-dsDNA is negative. Renal and CNS involvement are absent. What is the expected course after stopping hydralazine?',\n      correct: 'Symptoms and ANA positivity resolve within weeks to months of stopping the drug',\n      opts: [\n        'Symptoms and ANA positivity resolve within weeks to months of stopping the drug',\n        'Renal involvement will develop despite stopping the drug in 40% of cases',\n        'Anti-histone antibodies persist lifelong even after drug withdrawal',\n        'The condition is indistinguishable from idiopathic SLE and requires long-term hydroxychloroquine'\n      ],\n      exp:     '<strong>Drug-induced lupus (DIL)<\/strong> classically presents with arthritis, serositis, and constitutional symptoms. The <strong>anti-histone antibody<\/strong> is the serological hallmark; anti-dsDNA is characteristically <em>absent<\/em>, which helps distinguish DIL from idiopathic SLE. <strong>Renal and CNS involvement are rare<\/strong> in DIL. On stopping the offending drug, symptoms typically resolve within <strong>weeks to months<\/strong> and ANA titres gradually fall, though they may remain detectable for longer. Classic DIL-causing drugs: hydralazine, procainamide, isoniazid, minocycline, anti-TNF agents.',\n      imgId:   null\n    },\n\n    {\n      id:      4,\n      tag:     'Antiphospholipid Syndrome',\n      stem:    'A <strong>32-year-old woman<\/strong> has had two unexplained miscarriages at 14 and 16 weeks and one episode of DVT. Lupus anticoagulant is positive on two occasions 14 weeks apart. Anti-cardiolipin IgG is strongly positive (&gt;40 GPL units). She has no features of SLE. What is the diagnosis and the long-term treatment?',\n      correct: 'Primary APS; long-term warfarin with target INR 2.0&ndash;3.0',\n      opts: [\n        'Primary APS; long-term warfarin with target INR 2.0&ndash;3.0',\n        'Secondary APS in SLE; treat the underlying SLE first before anticoagulation',\n        'Primary APS; low-dose aspirin alone is sufficient for secondary prevention',\n        'Catastrophic APS; requires plasma exchange and IV immunoglobulin urgently'\n      ],\n      exp:     '<strong>Primary APS<\/strong> is diagnosed when thrombosis or pregnancy morbidity occurs with confirmed antiphospholipid antibodies (lupus anticoagulant, anti-cardiolipin IgG\/IgM &gt;40 units, or anti-&beta;2-GPI) on <strong>two occasions &ge;12 weeks apart<\/strong>, in the absence of another autoimmune disease. For venous thrombosis, <strong>warfarin with INR 2&ndash;3<\/strong> is standard. DOACs are generally avoided in triple-positive APS due to higher recurrence risk. Aspirin alone is insufficient after established thrombosis. Catastrophic APS involves rapid multi-organ failure affecting &ge;3 organs simultaneously.',\n      imgId:   null\n    },\n\n    {\n      id:      5,\n      tag:     'SLE &mdash; Neonatal Lupus',\n      stem:    'A <strong>28-year-old woman<\/strong> with Sjogren\\'s syndrome is found to have strongly positive <strong>anti-SSA (Ro)<\/strong> antibodies at her 12-week antenatal booking visit. She is currently well with no active disease flare. What is the principal fetal risk that requires surveillance and what is the surveillance modality?',\n      correct: 'Congenital heart block; serial fetal echocardiography from 16&ndash;26 weeks',\n      opts: [\n        'Congenital heart block; serial fetal echocardiography from 16&ndash;26 weeks',\n        'Neonatal thrombocytopaenia; serial fetal blood sampling from 28 weeks',\n        'Foetal lupus nephritis; serial fetal renal Doppler from 20 weeks',\n        'Neonatal seizures from CNS lupus; fetal MRI at 32 weeks'\n      ],\n      exp:     '<strong>Anti-SSA (Ro) antibodies<\/strong> cross the placenta and can interfere with the fetal cardiac conduction system, causing <strong>congenital heart block (CHB)<\/strong> &mdash; most critically complete (third-degree) AV block, which carries a mortality of 15&ndash;20% and often requires permanent pacing. The risk is approximately 2% in anti-SSA-positive mothers, rising to 15&ndash;20% after a previously affected pregnancy. <strong>Fetal echocardiography<\/strong> is performed weekly or fortnightly from <strong>16 to 26 weeks<\/strong> (the window of vulnerability). Skin rash and transient cytopaenias can also occur in the neonate but resolve as maternal antibodies clear.',\n      imgId:   null\n    }\n\n  ];\n\n  var answers  = {};\n  var answered = 0;\n  var shuffled = {};\n  var done     = false;\n\n  function byId(id) { return document.getElementById(id); }\n  function gid(suffix) { return byId(NS + '-' + suffix); }\n\n  function shuffleArr(arr) {\n    var a = arr.slice(), i, j, tmp;\n    for (i = a.length - 1; i > 0; i--) {\n      j = Math.floor(Math.random() * (i + 1));\n      tmp = a[i]; a[i] = a[j]; a[j] = tmp;\n    }\n    return a;\n  }\n\n  function countVal(val) {\n    var k, n = 0;\n    for (k in answers) {\n      if (answers.hasOwnProperty(k) && answers[k] === val) n++;\n    }\n    return n;\n  }\n\n  function buildPips() {\n    var cont = gid('pips'), i, q, wLine, wPip, line, pip;\n    cont.innerHTML = '';\n    for (i = 0; i < QS.length; i++) {\n      q = QS[i];\n      if (i > 0) {\n        wLine = document.createElement('div');\n        wLine.className = 'mr-pip-wrap';\n        line = document.createElement('div');\n        line.className = 'mr-pip-line';\n        line.id = NS + '-pl' + q.id;\n        wLine.appendChild(line);\n        cont.appendChild(wLine);\n      }\n      wPip = document.createElement('div');\n      wPip.className = 'mr-pip-wrap';\n      pip = document.createElement('div');\n      pip.className = 'mr-pip';\n      pip.id = NS + '-pip' + q.id;\n      pip.textContent = String(q.id);\n      wPip.appendChild(pip);\n      cont.appendChild(wPip);\n    }\n  }\n\n  function build() {\n    var cont, i, q, opts, card, top, numDiv, meta, tag, stem,\n        rule, optsDiv, expDiv, lbl, txt, imgDiv, imgSrc, j,\n        optEl, ltrSpan, txtSpan;\n\n    cont = gid('cases');\n    cont.innerHTML = '';\n    answers = {}; answered = 0; shuffled = {}; done = false;\n    gid('score').style.display = 'none';\n    buildPips();\n\n    for (i = 0; i < QS.length; i++) {\n      q = QS[i];\n      opts = shuffleArr(q.opts);\n      shuffled[q.id] = opts;\n\n      card = document.createElement('div');\n      card.className = 'mr-case';\n\n      top = document.createElement('div');\n      top.className = 'mr-case-top';\n\n      numDiv = document.createElement('div');\n      numDiv.className = 'mr-num';\n      numDiv.textContent = q.id < 10 ? 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Homogeneous: diffuse nuclear staining \u2014 anti-dsDNA (SLE-specific) and anti-histone (drug-induced lupus). Speckled: anti-Sm (SLE-specific), anti-SSA\/SSB (Sjogren's, neonatal lupus), anti-RNP (MCTD). Nucleolar: anti-Scl-70 and anti-RNA polymerase III \u2014 systemic sclerosis.&hellip;&nbsp;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[74,24,64],"tags":[],"class_list":["post-36947","post","type-post","status-publish","format-standard","hentry","category-morning-rounds","category-neet-pg","category-orthopaedics"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>SLE &amp; Antiphospholipid Syndrome - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/neet-pg\/sle-antiphospholipid-syndrome\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"SLE &amp; Antiphospholipid Syndrome - atsixty\" \/>\n<meta property=\"og:description\" content=\"Morning Rounds \u00b7 SLE &amp; Antiphospholipid Syndrome Homogeneous Speckled Nucleolar anti-dsDNA \/ anti-histone anti-Sm \/ anti-SSA \/ anti-SSB anti-Scl-70 \/ anti-RNA pol III ANA immunofluorescence patterns. Homogeneous: diffuse nuclear staining \u2014 anti-dsDNA (SLE-specific) and anti-histone (drug-induced lupus). Speckled: anti-Sm (SLE-specific), anti-SSA\/SSB (Sjogren&#039;s, neonatal lupus), anti-RNP (MCTD). 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