Difference between revisions of "Systemic lupus erythematosus"

(added lab tests)
(Clinical Features)
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*Cardiopulmonary
 
*Cardiopulmonary
 
**Pneumonia
 
**Pneumonia
***Cover for ''[[Listeria]]'' and ''[[Pseudmonas]]''
+
***Cover for ''[[Listeria]]'' and ''[[Pseudomonas]]''
 
**CAD
 
**CAD
 
***More common and more complications post-PCI
 
***More common and more complications post-PCI
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***Usually symmetric
 
***Usually symmetric
 
***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
 
*GI
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**Usually a nephritis
 
**Usually a nephritis
 
**Can cause a glomerulonephrosis
 
**Can cause a glomerulonephrosis
 
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==

Revision as of 00:07, 13 June 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:

  1. Malar rash
  2. Discoid rash
  3. Photosensitivity
  4. Oral ulcers
  5. Arthritis (polyarticular)
  6. Serositis (Pericarditis or pleuritis)
  7. Renal disorder (renal failure, protenuria, casts)
  8. Neurologic or psychotic symptoms
  9. Hematologic (anemia, thrombocytopenia, or leukopenia)
  10. Immunologic (+antibofy testing)
  11. ANA (positive ANA)

Organ system affected:

  • Musculoskeletal
    • Arthritis
      • Usually symmetric
      • Consider septic arthritis if there is a single inflamed joint
        • Cover for Salmonella in addition to standard coverage
  • GI
    • Lupus enteritis (mesenteric vasculitis)
      • Most common cause of acute abdominal pain
    • Pancreatitis
    • PUD
  • 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

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, C3,C4, direct Coombs')

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

Sources

  • Rosen's
  • Up to date