Ø Lupus
means wolf ,manifestation like
hungry wolf
Ø It
is autoimmune multisystem disease
Ø Etiology-Unknown
Ø Pathogenesis-Ab
against every component of cell
Ø Asian
0.03%
Ø Black
0.2%
Ø Onset-20-30
years ,gradual
Ø F:M =8:1
C/F
Ø
Fever ,malaise ,mayalgia ,arthralgia
Fever ,malaise ,mayalgia ,arthralgia
Ø Photosensitivity-Butterfly
rash under sun(Discoid rash in DLE)
Ø Fall
of scalp hair
Ø Signs
of arthritis are less common(Jaccoud's deformity)
Ø Spontaneous
abortion
Ø Pericarditis
,effusion
Ø Pleurisy
,effusion ,consolidation
Ø Red
urine
Ø Anemia/leukopenia/pancytopenia
Ø Psychosis
,seizures ,convulsion
Ø General
lymphadenopathy
Examination-Anemia ,lymphadenopathy ,loss of hair
,rash ,oral ulcer over hard palate
Systemic-Acc. to systemic features
Diagnostic criteria/ARA(11)
Ø Butterfly
rash
Ø Discoid
rash
Ø Oral
ulcer
Ø Photosensitivity
Ø Arthritis(Non
erosive ,2/more peripheral)
Ø Serositis
Ø Renal-Proteinuria
>0.5g/day ,3+ ,cellular cast
Ø Hematologic-Anemia/leukopenia
,4000/cmm/thrombocytopenia <100000/cmm
Ø Neurologic
-
Ø +ve
ANA Ab ,
Ø +ve
Anti DS DNA Ab
[4/more-Definite SLE]
Complication
Ø Renal-AGN
,NS ,ARF
Ø CVS-Pericarditis ,HF
,premature MI/due to vasculitis
Ø CNS-Psychosis
,convulsion
Ø DVT ,pul embolism
Investigation
Ø BLD-TC
,DC WBC ,HB ,ESR ,total bilirubin
Ø Routine-Total
urine protein(>3.5 g/1.3 sq.m/day in adult)
Ø Urine
RME-RBC cast
Ø CXR
Ø ECG-IHD/HB
Ø ANA-80% +ve(So here Anti DS DNA Ab +ve
30%)
Ø Anti
phospholipid Ab(In abortion pt/chance of thromboembolism)
[Prognosis depends on
renal system/vital organ involvement]
Histological change of renal involvement
Ø Every
glomerular disease may occurs
DD/+ve ANA
Ø Dermatomyositis
Ø Polymyositis
Ø Mixed
connective tissue disease/MCTD
Ø Sarcoidosis
Ø Rh
arthritis
DD of butterfly rash
Ø SLE
,DLE
Ø Dermatomyositis
Ø MCTD
Ø Sarcoidosis
Ø PKDL
Rx
Ø Nature
of disease must be explained
Ø Mild to moderate/no renal involvement-For
pain give NSAIDs ,hydroxychloroquine,if not controlled then give prednisolone 30-60mg/day
Ø If renal involvement
Methylprednisolone
10mg/kg/day IV for 3 days
Followed by Oral
prednisolone 30-60mg/day
Methotrexate
20-30mg/wk
If
side effects>Slowly decrease the dose and add chemotherapy