Systemic lupus erythematosus: Difference between revisions
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Revision as of 04:17, 26 March 2014
Background
- Autoimmune disorder affecting all systems
Epidemiology
- Female:Male 10:1
- Peak in 20s-30s
- 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
- Usually a nephritis
- Can cause a glomerulonephrosis
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
- Urine pregnancy
- ANA
- ESR
- UA
- Bedside echo if ill or hypotensive
- (Consider anti-DNA, anti-Smith, anti-Nuclear, anti-phospholipid)
Flare
- Bedside echo if ill or hypotensive
- CBC
- Chem
- UA
- Urine pregnancy
- 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
- Musculoskeletal symptoms can usually be managed as out patients
- Chest pain requires urgent ACS evaluation
- Infections usually require admission for antibiotics and systemic corticosteroids
See Also
- Arthritis
- Fever and Rash
- Lupus Anticoagulant
- Pericarditis
- Pericardial Effusion and Tamponade
- Acute Renal Failure
- Adrenal Crisis
Sources
- Rosen's
- Up to date