Difference between revisions of "Systemic lupus erythematosus"

Line 22: Line 22:
 
#ANA (positive ANA)
 
#ANA (positive ANA)
  
'''New Presentations'''
+
'''Organ system affected:'''
 
 
 
 
 
 
'''Flairs'''
 
 
*Cardiopulmonary
 
*Cardiopulmonary
 
**Pneumonia
 
**Pneumonia
Line 53: Line 49:
 
**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==
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*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==
*Steroids
+
*Inflammatory complications
**Stress-dose steroids if on or recently on chronic steroids
+
**Methylprednisolone 1-2mg/kg in most cases
**Inflammatory conditions: methylprednisolone 1-2mg/kg
+
*Infectious
***Pericarditis
+
**Stress dose steroids with hydrocortisone 100mg IV Q8hr if on or recently on steroids
***Lupus enteritis
 
  
 +
*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:

  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
  • 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


Differential Diagnosis

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

Sources

  • Rosen's
  • Up to date