Systemic lupus erythematosus

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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

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

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.