SLE

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

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