Systemic lupus erythematosus

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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