September 13, 2012

Criteria for diagnosis of Systemic Lupus Erythematosus

Systemic Lupus Erythematosus (SLE)
Systemic lupus erythematosus (SLE) is a long-term autoimmune disorder that may affect the skin, joints, kidneys, brain, and other organs. The underlying cause of autoimmune diseases is not fully known.

SLE is much more common in women than men. It may occur at any age, but appears most often in people between the ages of 10 and 50. African Americans and Asians are affected more often than people from other races. SLE may also be caused by certain drugs.

Symptoms vary from person to person, and may come and go. Almost everyone with SLE has joint pain and swelling. Some develop arthritis. Frequently affected joints are the fingers, hands, wrists, and knees.

To be diagnosed with lupus, there must be 4 out of 11 typical signs of the disease (see mnemonic below).

Tests used to diagnose SLE may include:
  • Antibody tests, including antinuclear antibody (ANA) panel
  • CBC
  • Chest x-ray
  • Kidney biopsy
  • Urinalysis
This disease may also alter the results of the following tests:
  • Antithyroglobulin antibody
  • Antithyroid microsomal antibody
  • Complement components (C3 and C4)
  • Coombs' test - direct
  • Cryoglobulins
  • ESR
  • Kidney function blood tests
  • Liver function blood tests
  • Rheumatoid factor
Please note that the list above is not all inclusive.

TREATMENT
There is no cure for SLE. The goal of treatment is to control symptoms.
Protective clothing, sunglasses, and sunscreen are encouraged when in the sun.

Mild disease may be treated with:
  • Nonsteroidal anti-inflammatory medications (NSAIDs) for pain of arthritis and pleurisy
  • Corticosteroid creams for skin rashes
  • Hydroxychloroquine (an antimalarial) and low-dose corticosteroids for skin and arthritis symptoms
Severe or life-threatening symptoms (such as hemolytic anemia, extensive heart or lung involvement, kidney disease, or central nervous system involvement) often require more aggressive treatment by specialists.

Treatment for more severe lupus may include:
  • High-dose corticosteroids or medications to decrease the immune system response
  • Cytotoxic drugs if corticosteroids prove unhelpful, or whose symptoms get worse when patients stop taking them. Cytotoxics have serious, severe side effects, thus patients must be closely monitored.
It is also important to have:
  • Preventive heart care
  • Up-to-date immunizations
  • Tests to screen for thinning of the bones (osteoporosis)
Talk therapy and support groups may help relieve depression and mood changes that may occur in patients with this disease.

Mnemonic of criteria for diagnosis of SLE

A helpful mnemonic of criteria for SLE diagnosis is:
Disco Malar SOAP N' HAIR
4 of 11, just don't care!
  1. Disco - Discoid rash
  2. Malar - Malar rash
  3. S - Serositis
  4. O - Oral ulcers
  5. A - Arthritis
  6. P - Photosensitivity
  7. N' - Neurologic disorder
  8. H - Hematologic disorder
  9. A - Antinuclear antibody
  10. I - Immunologic disorder
  11. R - Renal disorders
Presence of 4 of the above 11 criteria are diagnostic of SLE.

Reference(s):
  1. Makover M.E, Zieve D (reviewers). Systemic lupus erythematosus. PubMed Health, U.S. National Library of Medicine. Content accessed 13 September 2012. Available online at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001471/

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