SLE.doc (1) - Learning Issue: Systemic Lupus Erythematous...

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Learning Issue: Systemic Lupus Erythematous Name: Kelly Clark Definition An autoimmune disease characterized by multisystem microvascular inflammation and degeneration of antibodies Follows a relapsing/remitting course Causes Unknown Ideas: -immune system dysregulation - genetics - Epstein-Barr virus perpetuates autoimmunity Lupus-like syndrome: can be caused by drugs including, hydralazine(anti-hypertensive), isonazid (antibiotic), procainamide (anti-arrhythmic) Risk Factors Found more frequently in African Americans and hispanics Women of child-bearing age (14-64 y/o) are most likely to be affected Pathophysiology Poorly understood. characterized principally by injury to the skin, joints, kidney, and serosal membranes. The hallmark of the disease is the production of autoantibodies. Most common antibodies found in SLE are those directed against the cell nucleus (ANA). These antibodies bind DNA, RNA, nuclear proteins, and protein-DNA or protein-RNA complexes. Antibodies to double-stranded DNA and an RNA-protein complex called Sm are found almost exclusively in SLE. Immune complex deposition results in inflammation and vasculitis, causing multiorgan pathology. Signs and Symptoms Most common symptoms: Fatigue Fever Arthralgia Weight changes Arthralgia: the arthralgia associated with SLE can be asymmetrical and typically presents with pain out of proportion to the amount of swelling. Patient must have 4 or more of the 11 criteria to be diagnosed with SLE
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CRITERIA: 1. Malar rash 2. Discoid rash 3. Photosensitivity 4. Oral ulcers 5. Nonerosive arthritis 6. Serositis (pleuritis or pericarditis) 7. Renal disorder (persistent proteinuria, cellular casts) 8. Neurologic disorder -seizure or psychosis 9. Hematological disorder a. hemolytic anemia with reticulocytosis, OR b. leukopenia < 4000/mm 3 on ≥ 2 occasions, OR c. lymphopenia < 1500/mm 3 on ≥ 2 occasions, OR d. thrombocytopenia < 100 000/mm 3 in the absence of offending drug 10. Immunologic disorder a. anti-DNA: antibody to native DNA in abnormal titer, OR b. anti-Sm: presence of antibody to Sm
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SLE.doc (1) - Learning Issue: Systemic Lupus Erythematous...

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