Day 4- Systemic Lupus Erythematosus

Systemic Lupus Erythematosus

Work up (2012 SLICC SLE Criteria)

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  • Careful history and physical exam

    • clues include young age, african american race, painless mouth ulcers, arthralgias in the hands, pregnancy complications, rash, chest pain/pericardial symptoms, hematuria, chronic symptoms)

    • Acute cutaneous lupus: Lupus malaria rash etc.

    • Oral ulcers of nasal ulcers

    • non-scarring alopecia

    • synovitis involving 2 or more joints

    • serositis (typical pleurisy OR pleural effusions OR pleural rub)

      • typical pericardial pain for >1 day OR pericardial effusion OR pericardial rub OR pericarditis by ECG

    • Urine ACR >500mg protein/24hrs or RBC casts

    • neurologic: seizures, psychosis, mononeuritis multiplex, peripheral or cranial neurropathy

    • hemolytic anemia, leukopenia, thrombocytopenia

  • Careful drug history (?drug induced lupus)

Investigations

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Rheum Tutor

  • CBC

  • TSH

  • Urinalysis

  • If high suspicion for lupus:

    • ANA

    • ENA panel

    • C3, C4

    • ds-DNA

Treatment

If patient presenting with an acute lupus flare, consider steroids with a tapering course

  • Hydoxychloroquine takes several months to control symptoms

  • smoking cessation

  • sun protection

  • CV risk reduction

  • Consider bone mineral density testing, Ca and vit D for patients on long-term steroids

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