hey this is dr k from imedicalschool and todaywe are going to talk about systemic lupus erythematosis otherwise known as sle. so as the name suggests sle is a systemicautoimmune disorder that causes inflammation and affects all the major organs of the body.if you are interested in learning what you can do to help further lupus research or supportadvocacy for lupus patients make sure to check out the lupus foundation of america at lupus.org. since lupus is a systemic inflammatory disorderwhat are the symptoms of lupus? well lupus commonly presents with a multitude of generalizedsymptoms making the differential diagnoses quite broad. some common general symptomsinclude fever, fatigue, myalgias, arthritis,
and weight loss. there are additional symptomsand signs associated with lupus and we will talk about them next as we discuss how todiagnoses lupus. the most important step in understanding anydisease is grasping how to diagnose the disease. lets talk about how to diagnose lupus. thereare many pneumonics that can aid in remembering all the diagnostic criteria. the one i rememberis called dopamine rash. you need to have at least 4 criteria met to diagnose lupus. lets go through each one. the d representsdiscoid rash. a discoid rash is a disc shaped rash that is flat but has pronounced rednessat the borders. here we have a picture that demonstrates a discoid rash.
next we have oral ulcers. generally patientswill have ulcers that you find incidentally on exam. the way to differentiate these ulcersfrom infectious ulcers is that infectious ulcers are usually painful while ulcers fromlupus are generally painless. other skin findings include a photosensitiverash. photosensitive means that sun exposure triggers and can worsen the skin rash. patientsdo not need much sun exposure to really develop these rashes. in addition patients may experience jointpain otherwise known as arthralgia or joint inflammation known as arthritis. a classic physical exam finding for a lupuspatient is the malar rash. the malar rash
affects the cheeks and the bridge of the nose.in a truly classic rash it appears in the shape of a butterfly covering the nasal bridgeand both cheeks. in addition to rashes another criteria isimmunologic phenomenon. immunologic phenomenon include detection of anti-smooth muscle antibody,anti-double stranded dna, ant-ro and anti-la (otherwise known as ssa and ssb.) finallyif the lupus is drug induced you may see anti-histone antibodies. the next criteria are neurologic phenomenon.patient can develop altered mental status, seizures, stroke and headache. in additionto mental status changes lupus can damage the kidneys causing either a nephritic ora nephrotic disorder. nephritic disorder is
when the kidney is damaged causing proteinuriawith less than 3.5 g/day in the urine. in addition in a nephritic disorder a patientmay have high blood pressure and rbc casts. nephrotic disorder is when there is significantprotein loss of greater than 3.5 g/day in the urine. in addition patients have elevatedcholesterol levels, low albumin levels, and edema. one of the classical tests for lupusis ana or antinuclear antibody. ana is sensitive but not specific so a positive ana alone doesnot indicate lupus and you need to look for other criteria described by dopamine rashto make the diagnosis. other symptoms are characterized as serositis.this includes pleuritis, pericarditis, and peritonitis. finally patient can have hematologicalphenomenon. these include anemia, thrombocytopenia,
and hemolytic anemia. now that we have talkedabout the diagnostic criteria for lupus lets talk about how to monitor disease activity. lupus patient will need frequent routine labsto monitor disease activity. key labs include c3, c4, and ch50. these labs test the complementsystem. when lupus is highly active it leads to consumption of complement factors. in additiona rise in the igg anti-double stranded dna indicates an increase in disease activity.in addition to monitoring disease activity, as we know, lupus can cause kidney damage.one indicator of proliferative glomerulonephritis is a drop in c1q complement. the next importantstep is treatment of lupus one of the most important factors in decreasingdisease activity is to stop smoking. smoking
has been linked to worsening disease activityand worse outcomes. like i mentioned before lupus patients should be monitored with frequentlabs. these labs include cbc, esr, crp, urinalysis, spot urine and creatinine, ch50, c3, c4, andanti double stranded dna. in terms of actual therapy the first step is to begin with nsaids.if nsaids do not control symptoms, and they rarely do, hydroxychloroquine can be used.hydroxychloroquine is an antimalarial medication and has been shown to prevent damage to thecentral nervous system and kidneys. if symptoms continue to persist and major organs are beingaffected systemic corticosteroids should be administered. finally if these therapies donot work the patient needs to be escalated to methotrexate, cyclophosphamide, and azathioprinefor better system control.
well that was a brief review of systemic lupuserythematoisis. i hope you liked the video. if you did please share this video with yourfriends on facebook and twitter. give this video a like, place any comments or suggestionsdown below and most importantly subscribe. you can follow us on our facebook page imedicalschoolor twitter at imedschool finally check out our podcast on itunes under imedicalschool.this is dr k from imedicalschool and i will see you next time.
