Diferencia entre revisiones de «Systemic lupus erythematosus»

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==Clinical Features==
==Clinical Features==
'''SLICC Classification Criteria 2012''' <ref>Lisnevskaia L, et al. Systemic Lupus Erythematosus. Lancet. 2014 May 29. Epub ahead of print.</ref>
[[File:Lupusfoto.jpg|thumb|Typical "butterfly" malar rash.]]
Requirements: >4 of the following criteria (at least 1 clinical and 1 laboratory) '''OR''' biopsy proven lupus nephritis with  
[[File:PMC3410306 AD2012-834291.004.png|thumb|Palatal ulcer in SLE]]
[[File:PMC3410306 AD2012-834291.005.png|thumb|Subacute cutaneous SLE]]
SLICC Classification Criteria 2012 <ref>Lisnevskaia L, et al. Systemic Lupus Erythematosus. Lancet. 2014 May 29. Epub ahead of print.</ref>
Requirements: >4 of the following criteria (at least 1 clinical and 1 laboratory) OR biopsy proven lupus nephritis with  
positive ANA or Anti-dsDNA
positive ANA or Anti-dsDNA
*Clinical criteria
*Clinical criteria
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**Direct Coombs' test in the absence of haemolytic anaemia
**Direct Coombs' test in the absence of haemolytic anaemia


'''Organ system affected:'''
Organ system affected:
*Cardiopulmonary
*Cardiopulmonary
**[[Pneumonia]]
**[[Pneumonia]]
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**Malar [[rash]] across bridge of nose
**Malar [[rash]] across bridge of nose
**Discoid rash, erythematous with scale
**Discoid rash, erythematous with scale
**Treat with topical 1% [[hydrocortisone]]


*Renal
*Renal
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==Evaluation==
==Evaluation==
'''Undiagnosed'''
Undiagnosed
*CBC
*CBC
*Chem 10
*Chem 10
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*(Consider anti-DNA, anti-Smith, anti-Nuclear, anti-phospholipid, C3,C4, direct Coombs')
*(Consider anti-DNA, anti-Smith, anti-Nuclear, anti-phospholipid, C3,C4, direct Coombs')


'''Flare'''
Flare
*Bedside echo if ill or hypotensive
*Bedside echo if ill or hypotensive
*CBC
*CBC
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*As directed by organ system involved
*As directed by organ system involved


'''Drug Induced Lupus'''
Drug Induced Lupus
*Anti-histone-Ab positive 95% of the time
*Anti-histone-Ab positive 95% of the time
*Make sure to review medications
*Make sure to review medications
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*Must differentiate disease activity (flare) from infection
*Must differentiate disease activity (flare) from infection


'''Risk Factors for Infection''' <ref>Cuchacovich, R., & Gedalia, A. (2009). Pathophysiology and clinical spectrum of infections in systemic lupus erythematosus. Rheumatic diseases clinics of North America, 35(1), 75–93. doi:10.1016/j.rdc.2009.03.003</ref>
Risk Factors for Infection <ref>Cuchacovich, R., & Gedalia, A. (2009). Pathophysiology and clinical spectrum of infections in systemic lupus erythematosus. Rheumatic diseases clinics of North America, 35(1), 75–93. doi:10.1016/j.rdc.2009.03.003</ref>
*[[Neutropenia]]/Lymphopenia
*[[Neutropenia]]/Lymphopenia
*Hypocomplementemia
*Hypocomplementemia
*Immunosuppressive therapy (especially [[azathioprine]] <ref>Zhou, W. J., & Yang, C.-D. (2009). The causes and clinical significance of fever in systemic lupus erythematosus: a retrospective study of 487 hospitalised patients. Lupus, 18(9), 807–812. doi:10.1177/0961203309103870</ref>)
*Immunosuppressive therapy (especially [[azathioprine]] <ref>Zhou, W. J., & Yang, C.-D. (2009). The causes and clinical significance of fever in systemic lupus erythematosus: a retrospective study of 487 hospitalised patients. Lupus, 18(9), 807–812. doi:10.1177/0961203309103870</ref>)


'''Studies'''
Studies
*CRP: sensitivity 100%, specificity 90% >1.35mg/dL <ref>Kim, H.-A., Jeon, J.-Y., An, J.-M., Koh, B.-R., & Suh, C.-H. (2012). C-reactive protein is a more sensitive and specific marker for diagnosing bacterial infections in systemic lupus erythematosus compared to S100A8/A9 and procalcitonin. The Journal of rheumatology, 39(4), 728–734. doi:10.3899/jrheum.111044</ref>
*CRP: sensitivity 100%, specificity 90% >1.35mg/dL <ref>Kim, H.-A., Jeon, J.-Y., An, J.-M., Koh, B.-R., & Suh, C.-H. (2012). C-reactive protein is a more sensitive and specific marker for diagnosing bacterial infections in systemic lupus erythematosus compared to S100A8/A9 and procalcitonin. The Journal of rheumatology, 39(4), 728–734. doi:10.3899/jrheum.111044</ref>
*PCT: sensitivity 75%, specificity 75% <ref>Scirè, C. A., Cavagna, L., Perotti, C., Bruschi, E., Caporali, R., & Montecucco, C. (2006). Diagnostic value of procalcitonin measurement in febrile patients with systemic autoimmune diseases. Clinical and experimental rheumatology, 24(2), 123–128.</ref>
*PCT: sensitivity 75%, specificity 75% <ref>Scirè, C. A., Cavagna, L., Perotti, C., Bruschi, E., Caporali, R., & Montecucco, C. (2006). Diagnostic value of procalcitonin measurement in febrile patients with systemic autoimmune diseases. Clinical and experimental rheumatology, 24(2), 123–128.</ref>
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**[[Methylprednisolone]] 1-2mg/kg in most cases
**[[Methylprednisolone]] 1-2mg/kg in most cases
*Infectious
*Infectious
**Stress dose steroids with [[hydrocortisone]] 100mg IV Q8hr if on or recently on steroids
**Stress dose [[steroids]] with [[hydrocortisone]] 100mg IV Q8hr if on or recently on steroids
*Dermatologic
*Dermatologic
**[[Hydrocortisone]] 1% cream
**[[Hydrocortisone]] 1% cream
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*Mild flairs can have expedited out patient management
*Mild flairs can have expedited out patient management
*Musculoskeletal symptoms can usually be managed as out patients
*Musculoskeletal symptoms can usually be managed as out patients
*[[Chest pain]] requires urgent ACS evaluation
*[[Chest pain]] requires urgent [[ACS]] evaluation
*Infections usually require admission for antibiotics and systemic corticosteroids
*Infections usually require admission for [[antibiotics]] and systemic [[corticosteroids]]
 
 
==Medication Dosing==
{{MedicationDose
| drug = Methylprednisolone
| dose = 1-2mg/kg IV
| route = IV
| context = Acute SLE flare management
| indication = Systemic lupus erythematosus
| population = Adult
}}


==See Also==
==See Also==

Revisión actual - 09:37 22 mar 2026

Background

  • Autoimmune disorder affecting all systems
  • Also consider drug induced lupus

Epidemiology

  • Female:Male 10:1
  • Peak in 20s-30s
  • More common in Black patients

Clinical Features

Typical "butterfly" malar rash.
Palatal ulcer in SLE
Subacute cutaneous SLE

SLICC Classification Criteria 2012 [1] Requirements: >4 of the following criteria (at least 1 clinical and 1 laboratory) OR biopsy proven lupus nephritis with positive ANA or Anti-dsDNA

  • Immunological criteria
    • ANA
    • Anti-dsDNA
    • Anti-Sm
    • Antiphospholipid antibody
    • Low complement C3, low C4
    • Direct Coombs' test in the absence of haemolytic anaemia

Organ system affected:

  • Dermatologic
    • Malar rash across bridge of nose
    • Discoid rash, erythematous with scale
  • Renal
    • Usually a nephritis
    • Can cause a glomerulonephrosis

Differential Diagnosis

Polyarthritis

Algorithm for Polyarticular arthralgia

Causes of Glomerulonephritis

Evaluation

Undiagnosed

  • CBC
  • Chem 10
  • Urine pregnancy
  • ANA
  • ESR
  • Urinalysis
  • Bedside echocardiography 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
  • Urinalysis
  • Urine pregnancy
  • As directed by organ system involved

Drug Induced Lupus

Fever in SLE

  • Must differentiate disease activity (flare) from infection

Risk Factors for Infection [2]

Studies

  • CRP: sensitivity 100%, specificity 90% >1.35mg/dL [4]
  • PCT: sensitivity 75%, specificity 75% [5]

Management

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


Medication Dosing

Methylprednisolone 1-2mg/kg IV IV

See Also

References

  1. ↑ Lisnevskaia L, et al. Systemic Lupus Erythematosus. Lancet. 2014 May 29. Epub ahead of print.
  2. ↑ Cuchacovich, R., & Gedalia, A. (2009). Pathophysiology and clinical spectrum of infections in systemic lupus erythematosus. Rheumatic diseases clinics of North America, 35(1), 75–93. doi:10.1016/j.rdc.2009.03.003
  3. ↑ Zhou, W. J., & Yang, C.-D. (2009). The causes and clinical significance of fever in systemic lupus erythematosus: a retrospective study of 487 hospitalised patients. Lupus, 18(9), 807–812. doi:10.1177/0961203309103870
  4. ↑ Kim, H.-A., Jeon, J.-Y., An, J.-M., Koh, B.-R., & Suh, C.-H. (2012). C-reactive protein is a more sensitive and specific marker for diagnosing bacterial infections in systemic lupus erythematosus compared to S100A8/A9 and procalcitonin. The Journal of rheumatology, 39(4), 728–734. doi:10.3899/jrheum.111044
  5. ↑ Scirè, C. A., Cavagna, L., Perotti, C., Bruschi, E., Caporali, R., & Montecucco, C. (2006). Diagnostic value of procalcitonin measurement in febrile patients with systemic autoimmune diseases. Clinical and experimental rheumatology, 24(2), 123–128.
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