Systemic lupus erythematosus

Systemic lupus erythematosus, abbreviated SLE, is a common autoimmune disorder that typically affects multiple organs.

Diagnosis

The diagnosis rests on the evaluation of eleven clinical/laboratory criteria; if four of the eleven criteria are present, the diagnosis is made.

Criteria

Mnemonic DAMP AS RHINO:

• Discoid rash.
• ANA +ve
  • Sensitivity ~99%; negative finding essential excludes the diagnosis.
• Malar rash.
• Photosensitive.
• Arthritis.
• Serositis (pericardial or pleural).
• Renal dysfunction.
  • Proteinuria (>0.5 g/day) or cellular casts.
• Hematologic abnormality.
  • Includes: anemia, leukopenia, lymphopenia, thrombocytopenia, hypocomplementemia (low C3 & C4).
• Immunologic abnormality.
  • Anti-Smith antibody, APLA, VDRL false positive (test for syphilis).
• Neurologic abnormality, e.g. seizures, psychosis.
• Oral ulcer or nasal ulcer.

Prognosis

Survival:

• ~90% @ 10 years.

Mortality (leading causes):

• Active SLE - esp. kidney involvement.
• Infections.
• Thrombosis.

Microscopic

Lymph node pathology

Main article: Systemic lupus erythematosus lymphadenopathy

Skin

See: Lupus erythematosus.

SLE can have a variety of skin manifestations:

• Vacuolar interface dermatitis (lupus erythematosus) - classic finding.
• Panniculitis.
• Bullae (bullous systemic lupus erythematosus).
• Deep and superficial dermal, lymphocyte predominant, inflammation.

Pancreas

• Pancreatitis.

Kidney disease

Main article: Lupus nephritis

Vasculitis

Main article: Vasculitis

Images:

• Vasculitis assoc. with SLE - several images (upmc.edu).

Joint disease

See: Rheumatic joint disease.

See also

• Mixed connective tissue disease.
• Sjögren syndrome.
• Scleroderma.