Systemic lupus erythematosus: Difference between revisions
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***Consider septic arthritis if there is a single inflamed joint | ***Consider septic arthritis if there is a single inflamed joint | ||
****Cover for [[''Salmonella'']] in addition to standard coverage | ****Cover for [[''Salmonella'']] in addition to standard coverage | ||
*GI | |||
**Lupus enteritis (mesenteric vasculitis) | |||
***Most common cause of acute abdominal pain | |||
**Pancreatitis | |||
**PUD | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*Steroids | *Steroids | ||
**Stress-dose steroids if on or recently on chronic steroids | **Stress-dose steroids if on or recently on chronic steroids | ||
**Inflammatory conditions: methylprednisolone 1-2mg/kg | |||
***Pericarditis | |||
***Lupus enteritis | |||
Revision as of 22:41, 25 March 2014
Background
- Autoimmune disorder affecting all systems
Epidemiology
- Female:Male 10:1
- More common in African Americans
Clinical Features
Diagnostic Criteria: 4 out of 11 of the following:
- Malar rash
- Discoid rash
- Photosensitivity
- Oral ulcers
- Arthritis (polyarticular)
- Serositis (Pericarditis or pleuritis)
- Renal disorder (renal failure, protenuria, casts)
- Neurologic or psychotic symptoms
- Hematologic (anemia, thrombocytopenia, or leukopenia)
- Immunologic (+antibofy testing)
- ANA (positive ANA)
New Presentations
Flairs
- Cardiopulmonary
- Pneumonia
- Cover for Listeria and Pseudmonas
- CAD
- More common and more complications post-PCI
- PE
- Pericarditis
- Endocarditis
- Infectious and Libman-Sachs
- Pneumonia
- Neuropsychiatric/Altered mental status
- Non-convulsive status epilepticus
- CNS vasculitis
- Stroke
- Encephalitis
- Meningitis
- Musculoskeletal
- Arthritis
- Usually symmetric
- Consider septic arthritis if there is a single inflamed joint
- Cover for ''Salmonella'' in addition to standard coverage
- Arthritis
- GI
- Lupus enteritis (mesenteric vasculitis)
- Most common cause of acute abdominal pain
- Pancreatitis
- PUD
- Lupus enteritis (mesenteric vasculitis)
Differential Diagnosis
- Rheumatoid arthritis
- Sjogren's syndrome
- Dermatomyositis
- Polymyositis
- Stevens-Johnson syndrome
- Toxic Epidermal Necrolysis
- Septic arthritis
- Lyme disease
- Vasculitis
- Acute Rheumatic Fever
- Toxic Shock Syndrome
- TTP
- ITP
- DIC
Workup
Undiagnosed
- CBC
- Chem 10
- ANA
- ESR
- UA
- Bedside echo if ill or hypotensive
Flair
- Bedside echo if ill or hypotensive
- CBC
Management
- Steroids
- Stress-dose steroids if on or recently on chronic steroids
- Inflammatory conditions: methylprednisolone 1-2mg/kg
- Pericarditis
- Lupus enteritis
Disposition
- Suspected new diagnosis can have out patient workup if well appearing
See Also
- Arthritis
- Fever and Rash
- Lupus Anticoagulant
- Pericarditis
- Pericardial Effusion and Tamponade
- Acute Renal Failure
- Adrenal Crisis
Sources
- Rosen's
- Up to date