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Difference between revisions of "Systemic lupus erythematosus"
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==Diagnosis== | ==Diagnosis== | ||
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> | ||
* | *'''D'''iscoid rash. | ||
* | *'''A'''NA +ve | ||
* | **[[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. | ||
* | *'''M'''alar rash. | ||
* | *'''P'''hotosensitive. | ||
* | *'''A'''rthritis. | ||
* | *[[serositis|'''S'''erositis]] (pericardial or [[Systemic lupus erythematosus pleurisy|pleural]]). | ||
* | *'''R'''enal dysfunction. | ||
* | **Proteinuria (>0.5 g/day) or cellular casts. | ||
* | *'''H'''ematologic abnormality. | ||
* | **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=== | ||
{{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| | {{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| | {{Reflist|2}} | ||
[[Category:Clinical]] | [[Category:Clinical]] | ||
[[Category:Diagnosis]] | |||