Difference between revisions of "Systemic lupus erythematosus"

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==Diagnosis==
==Diagnosis==
It rests on the evaluation of 11 clinical and laboratory results.<ref>{{Cite journal  | last1 = Gill | first1 = JM. | last2 = Quisel | first2 = AM. | last3 = Rocca | first3 = PV. | last4 = Walters | first4 = DT. | title = Diagnosis of systemic lupus erythematosus. | journal = Am Fam Physician | volume = 68 | issue = 11 | pages = 2179-86 | month = Dec | year = 2003 | doi =  | PMID = 14677663 }}</ref>
The diagnosis rests on the evaluation of eleven clinical/laboratory criteria; if four of the eleven criteria are present, the diagnosis is made.<ref>{{Cite journal  | last1 = Gill | first1 = JM. | last2 = Quisel | first2 = AM. | last3 = Rocca | first3 = PV. | last4 = Walters | first4 = DT. | title = Diagnosis of systemic lupus erythematosus. | journal = Am Fam Physician | volume = 68 | issue = 11 | pages = 2179-86 | month = Dec | year = 2003 | doi =  | PMID = 14677663 }}</ref>


===Criteria===
===Criteria===
Mnemonic ''DAMP AS RHINO'':<ref>URL: [http://www.medicalmnemonics.com/cgi-bin/return_browse.cfm?browse=1&discipline=Rheumatology%20%2F%20Allergy http://www.medicalmnemonics.com/cgi-bin/return_browse.cfm?browse=1&discipline=Rheumatology%20%2F%20Allergy]. Accessed on: 11 September 2011.</ref>
Mnemonic ''DAMP AS RHINO'':<ref>URL: [http://www.medicalmnemonics.com/cgi-bin/return_browse.cfm?browse=1&discipline=Rheumatology%20%2F%20Allergy http://www.medicalmnemonics.com/cgi-bin/return_browse.cfm?browse=1&discipline=Rheumatology%20%2F%20Allergy]. Accessed on: 11 September 2011.</ref>
*Discoid rash.
*'''D'''iscoid rash.
*ANA +ve.
*'''A'''NA +ve
*Malar rash.
**[[Sensitivity]] ~99%;<ref>{{Cite journal  | last1 = Edworthy | first1 = SM. | last2 = Zatarain | first2 = E. | last3 = McShane | first3 = DJ. | last4 = Bloch | first4 = DA. | title = Analysis of the 1982 ARA lupus criteria data set by recursive partitioning methodology: new insights into the relative merit of individual criteria. | journal = J Rheumatol | volume = 15 | issue = 10 | pages = 1493-8 | month = Oct | year = 1988 | doi =  | PMID = 3060613 }}</ref> negative finding essential excludes the diagnosis.
*Photosensitive.
*'''M'''alar rash.
*Arthritis.
*'''P'''hotosensitive.
*Serositis (pericardial or pleural).
*'''A'''rthritis.
*Renal dysfunction.
*[[serositis|'''S'''erositis]] (pericardial or [[Systemic lupus erythematosus pleurisy|pleural]]).
*Hematologic abnormality.
*'''R'''enal dysfunction.
*Immunologic abnormality.
**Proteinuria (>0.5 g/day) or cellular casts.
*Neurologic abnormality, e.g. seizures, psychosis.
*'''H'''ematologic abnormality.
*Oral ulcer or nasal ulcer.
**Includes: [[anemia]], leukopenia, lymphopenia, thrombocytopenia, hypocomplementemia (low C3 & C4).
*'''I'''mmunologic abnormality.
**Anti-Smith antibody, [[APLA]], VDRL false positive (test for [[syphilis]]).
*'''N'''eurologic abnormality, e.g. seizures, psychosis.
*'''O'''ral ulcer or nasal ulcer.


===Prognosis===
===Prognosis===
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*Active SLE - esp. kidney involvement.
*Active SLE - esp. kidney involvement.
*Infections.
*Infections.
*Thrombosis.
*[[Thrombosis]].


==Lymph node pathology==
==Microscopic==
{{Main|Lymph_node_pathology#Systemic_lupus_erythematosus_lymphadenopathy}}
===Lymph node pathology===
{{Main|Systemic lupus erythematosus lymphadenopathy}}


==Pancreas==
===Skin===
:See: ''[[Lupus erythematosus]]''.
 
SLE can have a variety of skin manifestations:
*Vacuolar interface dermatitis ([[lupus erythematosus]]) - classic finding.
*[[Panniculitis]].
*Bullae ([[bullous disease|bullous]] systemic lupus erythematosus).
*Deep and superficial dermal, lymphocyte predominant, inflammation.
 
===Pancreas===
*[[Pancreatitis]].
*[[Pancreatitis]].


==Kidney disease==
===Kidney disease===
{{Main|Medical_kidney_diseases#Lupus_nephritis}}
{{Main|Lupus nephritis}}
 
===Vasculitis===
{{Main|Vasculitis}}
 
Images:
*[http://path.upmc.edu/cases/case202.html Vasculitis assoc. with SLE - several images (upmc.edu)].
 
===Joint disease===
:See: ''[[Rheumatic joint disease]]''.
 
==See also==
*[[Mixed connective tissue disease]].
*[[Sjögren syndrome]].
*[[Scleroderma]].


==References==
==References==
{{Reflist|1}}
{{Reflist|2}}


[[Category:Clinical]]
[[Category:Clinical]]
[[Category:Diagnosis]]

Latest revision as of 13:41, 9 May 2017

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.[1]

Criteria

Mnemonic DAMP AS RHINO:[2]

  • Discoid rash.
  • ANA +ve
    • Sensitivity ~99%;[3] 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:[4]

  • ~90% @ 10 years.

Mortality (leading causes):[4]

  • 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

Kidney disease

Main article: Lupus nephritis

Vasculitis

Main article: Vasculitis

Images:

Joint disease

See: Rheumatic joint disease.

See also

References

  1. ↑ Gill, JM.; Quisel, AM.; Rocca, PV.; Walters, DT. (Dec 2003). "Diagnosis of systemic lupus erythematosus.". Am Fam Physician 68 (11): 2179-86. PMID 14677663.
  2. ↑ URL: http://www.medicalmnemonics.com/cgi-bin/return_browse.cfm?browse=1&discipline=Rheumatology%20%2F%20Allergy. Accessed on: 11 September 2011.
  3. ↑ Edworthy, SM.; Zatarain, E.; McShane, DJ.; Bloch, DA. (Oct 1988). "Analysis of the 1982 ARA lupus criteria data set by recursive partitioning methodology: new insights into the relative merit of individual criteria.". J Rheumatol 15 (10): 1493-8. PMID 3060613.
  4. ↑ 4.0 4.1 Madhok, R.; Wu, O. (Nov 2007). "Systemic lupus erythematosus.". Am Fam Physician 76 (9): 1351-3. PMID 18019880.
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