Systemic lupus erythematosus: Difference between revisions
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#ANA (positive ANA) | #ANA (positive ANA) | ||
''' | '''Organ system affected:''' | ||
*Cardiopulmonary | *Cardiopulmonary | ||
**Pneumonia | **Pneumonia | ||
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**Lupus enteritis (mesenteric vasculitis) | **Lupus enteritis (mesenteric vasculitis) | ||
***Most common cause of acute abdominal pain | ***Most common cause of acute abdominal pain | ||
**Pancreatitis | **[[Pancreatitis]] | ||
**PUD | **PUD | ||
*Dermatologic | |||
**Malar rash across bridge of nose | |||
**Discoid rash, erythematous with scale | |||
**Treat with topical 1% hydrocortisone | |||
*Renal | |||
** | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 80: | Line 85: | ||
*UA | *UA | ||
*Bedside echo if ill or hypotensive | *Bedside echo if ill or hypotensive | ||
*(Consider anti-DNA, anti-Smith, anti-Nuclear, anti-phospholipid) | |||
'''Flair''' | '''Flair''' | ||
*Bedside echo if ill or hypotensive | *Bedside echo if ill or hypotensive | ||
*CBC | *CBC | ||
*Chem | |||
*UA | |||
*As directed by organ system involved | |||
==Management== | ==Management== | ||
* | *Inflammatory complications | ||
**Methylprednisolone 1-2mg/kg in most cases | |||
** | *Infectious | ||
* | **Stress dose steroids with hydrocortisone 100mg IV Q8hr if on or recently on steroids | ||
** | |||
*Dermatologic | |||
**Hydrocortisone 1% cream | |||
==Disposition== | ==Disposition== | ||
*Suspected new diagnosis can have out patient workup if well appearing | *Suspected new diagnosis can have out patient workup if well appearing | ||
*Mild flairs can have expedited out patient management | |||
*High-risk population, low threshold to admit | |||
==See Also== | ==See Also== | ||
Revision as of 22:59, 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)
Organ system affected:
- 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)
- Dermatologic
- Malar rash across bridge of nose
- Discoid rash, erythematous with scale
- Treat with topical 1% hydrocortisone
- Renal
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
- (Consider anti-DNA, anti-Smith, anti-Nuclear, anti-phospholipid)
Flair
- Bedside echo if ill or hypotensive
- CBC
- Chem
- UA
- As directed by organ system involved
Management
- Inflammatory complications
- Methylprednisolone 1-2mg/kg in most cases
- Infectious
- Stress dose steroids with hydrocortisone 100mg IV Q8hr if on or recently on steroids
- Dermatologic
- Hydrocortisone 1% cream
Disposition
- Suspected new diagnosis can have out patient workup if well appearing
- Mild flairs can have expedited out patient management
- High-risk population, low threshold to admit
See Also
- Arthritis
- Fever and Rash
- Lupus Anticoagulant
- Pericarditis
- Pericardial Effusion and Tamponade
- Acute Renal Failure
- Adrenal Crisis
Sources
- Rosen's
- Up to date