SlideShare a Scribd company logo
1 of 50
Download to read offline
SLE
             BY
DR. EHAB ELTORABY
     MD GENERAL MEDICINE
RHEUMATOLOGY &IMMUNOLOGY UNIT
Agenda
  Definition of SLE
  Causes of SLE
  Clinical Picture of SLE
  Investigations of SLE
  Treatment of SLE
Definition
   Systemic lupus erythematosus (SLE) is
    a multi-system auto-immune disease
    that is caused by tissue damage
    resulting from antibody and
    complement fixing immune complex
    deposition
   It is characterized by states of
    exacerbation and remission
Definition (Cont.)
   The immune system loses the ability to
    differentiate between foreign cells and
    it’s own cells and tissues
   Antibodies against the immune system
    are formed
   The immune complexes that are formed
    build up in the tissue causing
    inflammation, injury to the tissue, and
    pain
INCIDENCE OF LUPUS

   Between 500,000 to 1.5 million
    Americans have lupus.
   80-90% of lupus patients are female.
   80% of lupus patients are between 15
    and 45 years of age.
   Lupus affects more African Americans,
    Asian Americans, Hispanics, and Native
    Americans than Caucasians.
WHAT CAUSES LUPUS?


 Genetics   Hormones


     Environment
Etiology
   The specific cause is unknown
   Genetic factors may play a role
   Environmental agents
   Drugs or other chemical agents
   Dietary factors
   Ultraviolet radiation
   Infectious agents
LUPUS IS…

   Different for each person.
   A disease that ranges from mild to life
    threatening.
   Characterized by flares and remissions.
TYPES OF LUPUS

   Discoid or Cutaneous Lupus (DLE)
   Drug Induced Lupus (DIL)
   Neonatal Lupus
   Systemic Lupus Erythematous (SLE)
DISCOID LUPUS
   Affects the skin, hair or mucous
    membranes.
   Identified by a rash or lesions.
   Diagnosed by biopsy of rash.
   10% will evolve into SLE.
   Treatment includes topical or
    interlesional steroids; antimalarials.
SLE
Discoid Rash
DRUG INDUCED LUPUS
   Develops after long-term use of certain
    medications.
   Most common in men over 50 years old.
   Symptoms are similar to SLE.
   Most important treatment is to recognize
    medication and discontinue use.
   Once medication is stopped, symptoms usually
    disappear completely within 6 months.
NEONATAL LUPUS
   Occurs when the mother’s antibodies cross over
    the placenta to the baby.
   Can affect the skin, heart, liver and/or blood of
    the fetus and newborn.
   Good prenatal care can prevent most problems.
SYSTEMIC LUPUS
       ERYTHEMATOSUS
   Can affect any organ in the body
    including the joints, skin, lungs, heart,
    blood, kidney, or nervous system.
   Can range from mild to life threatening.
   No two people will have identical
    symptoms.
COMMON
SYMPTOMS OF SLE
    Achy joints
    Fever
    Fatigue
    Skin Rashes
OTHER
            LUPUS SYMPTOMS
    Chest pain                Headache
    Hair loss                 Dizziness
    Mouth sores               Depression
    Photosensitivity          Seizures
    Anemia                    Memory disturbances
   Repeated miscarriages
ORGAN INVOLVEMENT
       WITH LUPUS

   Kidneys              Blood vessels
   Lungs                Blood
   Central nervous      Heart
    system
DIAGNOSING LUPUS

   Medical history (including family history)
   Complete physical examination
   Laboratory tests
   Skin or kidney biopsy
ACR DIAGNOSTIC CRITERIA
Skin criteria             Systemic criteria
1.   Butterfly rash       5.   Arthritis
2.   Discoid rash         6.   Serositis
3.   Photosensitivity     7.   Kidney disorder
4.   Oral ulcers          8.   Neurologic disorder

           Laboratory criteria
            9. Hematologic abnormalities
           10. Immunologic disorder
           11. Antinuclear antibody
Criterion                                      Definition
    Malar Rash     Rash over the cheeks

  Discoid Rash     Red raised patches
       DIAGNOSIS resulting in the development of or increase
Photosensitivity
           Reaction to sunlight,
                   in skin rash

    Oral Ulcers    Ulcers in the nose or mouth, usually painless

       Arthritis   Nonerosive arthritis involving two or more peripheral joints
                   (arthritis in which the bones around the joints do not become
                   destroyed)

       Serositis   Pleuritis or pericarditis (inflammation of the lining of the lung or
                   heart)

Renal Disorder     Excessive protein in the urine (greater than 0.5 gm/day or 3+ on
                   test sticks) and/or cellular casts (abnormal elements the urine,
                   derived from red and/or white cells and/or kidney tubule cells)
Criterion                                                    Definition
   Neurologic      Seizures (convulsions) and/or psychosis in the absence of
     Disorder      drugs or metabolic disturbances which are known to cause

  DIAGNOSIS        such effects


  Hematologic      Hemolytic anemia , leukopenia , lymphopenia or
     Disorder      thrombocytopenia. The leukopenia and lymphopenia must be
                   detected on two or more occasions. The thrombocytopenia
                   must be detected in the absence of drugs known to induce it.




   Antinuclear     Positive test for antinuclear antibodies (ANA) in the absence
     Antibody      of drugs known to induce it.

 Immunologic       Positive anti-double stranded anti-DNA test, positive anti-Sm
    Disorder       test, positive antiphospholipid antibody such as
                   anticardiolipin, or false positive syphilis test (VDRL).

            Adapted from: Tan, E.M., et. al. The 1982 Revised Criteria for the Classification of SLE. Arth Rheum 25:
                                                         1271-1277.
Malar Rash
Oral Ulcers
SLE
Systemic Lupus Erythematosus

   Head and Neck Manifestations
     Malar rash first sign in 50%
     Erythematous maculopapular

      eruption after sun exposure
     Oral ulceration
Musculoskeletal System

    All joints can be affected,
     however the wrists, knees,
     ankles, elbows, and shoulders are
     most common
Musculoskeletal System
(Cont.)
    Hand deformities can include ulnar
     deviation and subluxation, swan neck
     deformities, and subluxation of thumb
     interphalangeal joints
     Reversible subluxation has been observed
     in the knees
SLE
SLE
Cardiovascular System

 Pericarditis is the most
  common cardiac
  manifestation
 myocarditis

 Endocarditis with

  characteristic lesion
 of the cardiac valve
Pulmonary System

   Pleurisy is the most common
    manifestation of pulmonary
    involvement
   Interstitial lung disease
   Pulmonary embolisms
Gastrointestinal Sytem
   Difficulty swallowing
   Gastric reflux disease
   Anorexia, nausea, or vomiting may be present
   Pancreatitis
Raynaud’s Phenomena




     Http://www.dermis.net/doi
      a
Renal manifestations


   Tend to appear within the 1st 2yrs of SLE
   Almost ½ have asymptomatic urine
    abnormalities
      Proteinuria - dominant feature

      Haematuria – almost always present but

       not in isolation
Nervous System
   Neuropsychiatric manifestations of
    lupus occur frequently
       May be mild to severe
       Any location in the nerve system may be
        affected (brain, spinal cord, peripheral
        system)
Nervous System (Cont.)
   Central Nerve System
      Acute confusional

       state
      Psychosis

      Anxiety disorder

      Headache

      Cerebrovascular

       disease
Nervous System (Cont.)
   Peripheral Nerve System
      Cranial neuropathy

      Mononeuropathy

      Polyneuropathy
COMMON LABORATORY
      TESTS

   Antinuclear Antibody (ANA)
   Anti DNA
   Anti-Sm
   Anti-RNP
   Anti-Ro
   Anti-La
OTHER LABORATORY
                TESTS

   CBC (RBC, WBC, platelets)      Rheumatoid Factor
   Urinalysis                     Skin biopsy
   Sedimentation Rate (ESR)       Kidney Biopsy
EFFECT OF LABORATORY TESTS
      WITH INCREASED LUPUS ACTIVITY


C reactive protein (CRP)
 Sedimentation rate (ESR)      CBC (WBC, RBC,
 Anti DNA
                                  platelets)
 Liver and Kidney
                                Complement
  Function tests
                                Serum albumin
 CPK
 Urine protein or cell casts
LUPUS TREATMENT


    Team effort
    Tailored
    Tentative
LUPUS PHYSICIANS
    Family Practitioner
    Internist
    Rheumatologist
    Clinical Immunologist
    Dermatologist
    Nephrologist
    Other specialists
COMMON
LUPUS MEDICATIONS
   NSAIDs
   Antimalarials
   Corticosteroids
   Immunosuppressants
   Investigational (research)
NSAIDs
   Aspirin
   Ibuprofen
   Indomethacin
CORTICOSTEROIDS

    Prednisone
    Prednisolone
    Methylprednisolone
    Hydrocortisone
ANTIMALARIALS

   Chloroquine
IMMUNE SUPPRESSANTS

   Cyclophosphamide
   Azathioprine
PREVENTIVE MEASURES
      Sun precautions
      Rest
      Nutrition/diet
      Exercise
      Moist heat
      Prevent infection
      Don’t smoke
Th a n k Y o u

More Related Content

What's hot (20)

Lupus nephritis
Lupus nephritisLupus nephritis
Lupus nephritis
 
Rheumatoid Arthritis
Rheumatoid ArthritisRheumatoid Arthritis
Rheumatoid Arthritis
 
Psoriasis
PsoriasisPsoriasis
Psoriasis
 
Nephrotic syndrome
Nephrotic syndrome Nephrotic syndrome
Nephrotic syndrome
 
Gout
GoutGout
Gout
 
Reactive Arthritis
Reactive  ArthritisReactive  Arthritis
Reactive Arthritis
 
Psoriasis
PsoriasisPsoriasis
Psoriasis
 
Peripheral Neuropathy
Peripheral NeuropathyPeripheral Neuropathy
Peripheral Neuropathy
 
Myasthenia Gravis
Myasthenia GravisMyasthenia Gravis
Myasthenia Gravis
 
Tuberculous meningitis
Tuberculous meningitisTuberculous meningitis
Tuberculous meningitis
 
Rheumatoid arthritis ppt by ann..
Rheumatoid arthritis ppt by ann..Rheumatoid arthritis ppt by ann..
Rheumatoid arthritis ppt by ann..
 
Ulcerative colitis
Ulcerative colitisUlcerative colitis
Ulcerative colitis
 
Dermatomyositis
DermatomyositisDermatomyositis
Dermatomyositis
 
Connective tissue diseases (7)
Connective tissue diseases (7)Connective tissue diseases (7)
Connective tissue diseases (7)
 
Rheumatoid arthritis
Rheumatoid arthritisRheumatoid arthritis
Rheumatoid arthritis
 
Inflammatory bowel disease
Inflammatory bowel diseaseInflammatory bowel disease
Inflammatory bowel disease
 
Polymyositis
PolymyositisPolymyositis
Polymyositis
 
Pancytopenia
PancytopeniaPancytopenia
Pancytopenia
 
Liver cirrhosis
Liver cirrhosisLiver cirrhosis
Liver cirrhosis
 
Pleurisy
PleurisyPleurisy
Pleurisy
 

Similar to SLE

systemiclupuserythematosus-180125101602.pdf
systemiclupuserythematosus-180125101602.pdfsystemiclupuserythematosus-180125101602.pdf
systemiclupuserythematosus-180125101602.pdfShinilLenin
 
systemiclupuserythematosus-180125101602.pptx
systemiclupuserythematosus-180125101602.pptxsystemiclupuserythematosus-180125101602.pptx
systemiclupuserythematosus-180125101602.pptxDinamGyatsoAadHenmoo
 
Systemic lupus erythematosus (sle)
Systemic lupus erythematosus (sle)Systemic lupus erythematosus (sle)
Systemic lupus erythematosus (sle)Qais Ali Asad
 
How do we diagnose lupus?
How do we diagnose lupus?How do we diagnose lupus?
How do we diagnose lupus?LupusNY
 
Systemic Lupus Erythematoses
Systemic Lupus ErythematosesSystemic Lupus Erythematoses
Systemic Lupus Erythematosesdrangelosmith
 
Systemic lupus erythematosus (lupus): Disease of the immune system
Systemic lupus erythematosus (lupus): Disease of the immune systemSystemic lupus erythematosus (lupus): Disease of the immune system
Systemic lupus erythematosus (lupus): Disease of the immune systemLazoi Lifecare Private Limited
 
Systemic lupus erythematosus
Systemic lupus erythematosusSystemic lupus erythematosus
Systemic lupus erythematosusKoustav Jana
 
Lupus Erythematosus Research Papers
Lupus Erythematosus Research PapersLupus Erythematosus Research Papers
Lupus Erythematosus Research PapersAngel Jordan
 
Lupus Erythematosus Research Papers
Lupus Erythematosus Research PapersLupus Erythematosus Research Papers
Lupus Erythematosus Research PapersAmy Holmes
 
Multiple Sclerosis - by MHR Corp
Multiple Sclerosis - by MHR CorpMultiple Sclerosis - by MHR Corp
Multiple Sclerosis - by MHR CorpMohd Hanafi
 
Systemic lupus erythematosus
Systemic lupus erythematosusSystemic lupus erythematosus
Systemic lupus erythematosusShahdYr
 
Diagnosis and management sle
Diagnosis  and  management sleDiagnosis  and  management sle
Diagnosis and management sleAshvini Choudhary
 
Systemic Lupus Erythematosus Research Paper
Systemic Lupus Erythematosus Research PaperSystemic Lupus Erythematosus Research Paper
Systemic Lupus Erythematosus Research PaperKelly Flores
 

Similar to SLE (20)

SLE
SLESLE
SLE
 
systemiclupuserythematosus-180125101602.pdf
systemiclupuserythematosus-180125101602.pdfsystemiclupuserythematosus-180125101602.pdf
systemiclupuserythematosus-180125101602.pdf
 
systemiclupuserythematosus-180125101602.pptx
systemiclupuserythematosus-180125101602.pptxsystemiclupuserythematosus-180125101602.pptx
systemiclupuserythematosus-180125101602.pptx
 
Systemic lupus erythematosus (sle)
Systemic lupus erythematosus (sle)Systemic lupus erythematosus (sle)
Systemic lupus erythematosus (sle)
 
How do we diagnose lupus?
How do we diagnose lupus?How do we diagnose lupus?
How do we diagnose lupus?
 
Systemic Lupus Erythematoses
Systemic Lupus ErythematosesSystemic Lupus Erythematoses
Systemic Lupus Erythematoses
 
SLE.pptx
SLE.pptxSLE.pptx
SLE.pptx
 
SLE.pptx
SLE.pptxSLE.pptx
SLE.pptx
 
Systemic lupus erythematosus (lupus): Disease of the immune system
Systemic lupus erythematosus (lupus): Disease of the immune systemSystemic lupus erythematosus (lupus): Disease of the immune system
Systemic lupus erythematosus (lupus): Disease of the immune system
 
Systemic lupus erythematosus
Systemic lupus erythematosusSystemic lupus erythematosus
Systemic lupus erythematosus
 
Lupus Erythematosus Research Papers
Lupus Erythematosus Research PapersLupus Erythematosus Research Papers
Lupus Erythematosus Research Papers
 
Lupus Erythematosus Research Papers
Lupus Erythematosus Research PapersLupus Erythematosus Research Papers
Lupus Erythematosus Research Papers
 
Systemic Lupus Erythematosus
Systemic Lupus ErythematosusSystemic Lupus Erythematosus
Systemic Lupus Erythematosus
 
Multiple Sclerosis - by MHR Corp
Multiple Sclerosis - by MHR CorpMultiple Sclerosis - by MHR Corp
Multiple Sclerosis - by MHR Corp
 
SLE & APS for undergraduates: diagnosis & treatment.
SLE & APS for undergraduates: diagnosis & treatment.SLE & APS for undergraduates: diagnosis & treatment.
SLE & APS for undergraduates: diagnosis & treatment.
 
Systemic lupus erythematosus
Systemic lupus erythematosusSystemic lupus erythematosus
Systemic lupus erythematosus
 
Diagnosis and management sle
Diagnosis  and  management sleDiagnosis  and  management sle
Diagnosis and management sle
 
Systemic Lupus Erythematosus Research Paper
Systemic Lupus Erythematosus Research PaperSystemic Lupus Erythematosus Research Paper
Systemic Lupus Erythematosus Research Paper
 
Uctd4b
Uctd4bUctd4b
Uctd4b
 
JIA 101: Welcome to the Club
JIA 101: Welcome to the ClubJIA 101: Welcome to the Club
JIA 101: Welcome to the Club
 

More from Omar Moatamed

Physiology of Menopause
Physiology of MenopausePhysiology of Menopause
Physiology of MenopauseOmar Moatamed
 
Vessels & nerves of lower limb
Vessels & nerves of lower limbVessels & nerves of lower limb
Vessels & nerves of lower limbOmar Moatamed
 
Histology of the breast
Histology of the breastHistology of the breast
Histology of the breastOmar Moatamed
 
Pharmacodynamics revised
Pharmacodynamics   revisedPharmacodynamics   revised
Pharmacodynamics revisedOmar Moatamed
 
Tolerance & autoimmunity
Tolerance & autoimmunityTolerance & autoimmunity
Tolerance & autoimmunityOmar Moatamed
 
Psychological impact of chronic illness2
Psychological impact of chronic illness2Psychological impact of chronic illness2
Psychological impact of chronic illness2Omar Moatamed
 
The back of the thigh and popliteal fossa
The back of the thigh and popliteal fossaThe back of the thigh and popliteal fossa
The back of the thigh and popliteal fossaOmar Moatamed
 
Phobia & its Treatment
Phobia & its TreatmentPhobia & its Treatment
Phobia & its TreatmentOmar Moatamed
 
Organization of the ll, front and medial sides of thigh
Organization of the ll, front and medial sides of thighOrganization of the ll, front and medial sides of thigh
Organization of the ll, front and medial sides of thighOmar Moatamed
 
Histology (Skin) - Part 2
Histology (Skin) - Part 2Histology (Skin) - Part 2
Histology (Skin) - Part 2Omar Moatamed
 

More from Omar Moatamed (20)

Physiology of Menopause
Physiology of MenopausePhysiology of Menopause
Physiology of Menopause
 
Vessels & nerves of lower limb
Vessels & nerves of lower limbVessels & nerves of lower limb
Vessels & nerves of lower limb
 
Histology of the breast
Histology of the breastHistology of the breast
Histology of the breast
 
Anti cancer drugs
Anti cancer drugsAnti cancer drugs
Anti cancer drugs
 
Pharmacogenetics
PharmacogeneticsPharmacogenetics
Pharmacogenetics
 
Anti cancer drugs
Anti cancer drugsAnti cancer drugs
Anti cancer drugs
 
Pharmacodynamics revised
Pharmacodynamics   revisedPharmacodynamics   revised
Pharmacodynamics revised
 
Staging of cancer
Staging of  cancerStaging of  cancer
Staging of cancer
 
Anatomy of the Leg
Anatomy of the LegAnatomy of the Leg
Anatomy of the Leg
 
General Mycology
General MycologyGeneral Mycology
General Mycology
 
Tolerance & autoimmunity
Tolerance & autoimmunityTolerance & autoimmunity
Tolerance & autoimmunity
 
Psychological impact of chronic illness2
Psychological impact of chronic illness2Psychological impact of chronic illness2
Psychological impact of chronic illness2
 
The back of the thigh and popliteal fossa
The back of the thigh and popliteal fossaThe back of the thigh and popliteal fossa
The back of the thigh and popliteal fossa
 
Gluteal region
Gluteal regionGluteal region
Gluteal region
 
Gulteal region
Gulteal regionGulteal region
Gulteal region
 
Bacterial Virulence
Bacterial VirulenceBacterial Virulence
Bacterial Virulence
 
Hypersensitivity
HypersensitivityHypersensitivity
Hypersensitivity
 
Phobia & its Treatment
Phobia & its TreatmentPhobia & its Treatment
Phobia & its Treatment
 
Organization of the ll, front and medial sides of thigh
Organization of the ll, front and medial sides of thighOrganization of the ll, front and medial sides of thigh
Organization of the ll, front and medial sides of thigh
 
Histology (Skin) - Part 2
Histology (Skin) - Part 2Histology (Skin) - Part 2
Histology (Skin) - Part 2
 

Recently uploaded

How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17Celine George
 
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfMaximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfTechSoup
 
How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17Celine George
 
Human-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming ClassesHuman-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming ClassesMohammad Hassany
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapitolTechU
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.raviapr7
 
The Singapore Teaching Practice document
The Singapore Teaching Practice documentThe Singapore Teaching Practice document
The Singapore Teaching Practice documentXsasf Sfdfasd
 
Benefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationBenefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationMJDuyan
 
HED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfHED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfMohonDas
 
How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesCeline George
 
3.21.24 The Origins of Black Power.pptx
3.21.24  The Origins of Black Power.pptx3.21.24  The Origins of Black Power.pptx
3.21.24 The Origins of Black Power.pptxmary850239
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxKatherine Villaluna
 
How to Solve Singleton Error in the Odoo 17
How to Solve Singleton Error in the  Odoo 17How to Solve Singleton Error in the  Odoo 17
How to Solve Singleton Error in the Odoo 17Celine George
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxheathfieldcps1
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.EnglishCEIPdeSigeiro
 
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...Nguyen Thanh Tu Collection
 
Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxraviapr7
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxraviapr7
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17Celine George
 
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfP4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfYu Kanazawa / Osaka University
 

Recently uploaded (20)

How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17How to Add a many2many Relational Field in Odoo 17
How to Add a many2many Relational Field in Odoo 17
 
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfMaximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
 
How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17How to Make a Field read-only in Odoo 17
How to Make a Field read-only in Odoo 17
 
Human-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming ClassesHuman-AI Co-Creation of Worked Examples for Programming Classes
Human-AI Co-Creation of Worked Examples for Programming Classes
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptx
 
Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.Drug Information Services- DIC and Sources.
Drug Information Services- DIC and Sources.
 
The Singapore Teaching Practice document
The Singapore Teaching Practice documentThe Singapore Teaching Practice document
The Singapore Teaching Practice document
 
Benefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive EducationBenefits & Challenges of Inclusive Education
Benefits & Challenges of Inclusive Education
 
HED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfHED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdf
 
How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 Sales
 
3.21.24 The Origins of Black Power.pptx
3.21.24  The Origins of Black Power.pptx3.21.24  The Origins of Black Power.pptx
3.21.24 The Origins of Black Power.pptx
 
Practical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptxPractical Research 1 Lesson 9 Scope and delimitation.pptx
Practical Research 1 Lesson 9 Scope and delimitation.pptx
 
How to Solve Singleton Error in the Odoo 17
How to Solve Singleton Error in the  Odoo 17How to Solve Singleton Error in the  Odoo 17
How to Solve Singleton Error in the Odoo 17
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptx
 
Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.Easter in the USA presentation by Chloe.
Easter in the USA presentation by Chloe.
 
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
 
Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptx
 
Education and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptxEducation and training program in the hospital APR.pptx
Education and training program in the hospital APR.pptx
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17
 
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfP4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
 

SLE

  • 1. SLE BY DR. EHAB ELTORABY MD GENERAL MEDICINE RHEUMATOLOGY &IMMUNOLOGY UNIT
  • 2. Agenda Definition of SLE Causes of SLE Clinical Picture of SLE Investigations of SLE Treatment of SLE
  • 3. Definition  Systemic lupus erythematosus (SLE) is a multi-system auto-immune disease that is caused by tissue damage resulting from antibody and complement fixing immune complex deposition  It is characterized by states of exacerbation and remission
  • 4. Definition (Cont.)  The immune system loses the ability to differentiate between foreign cells and it’s own cells and tissues  Antibodies against the immune system are formed  The immune complexes that are formed build up in the tissue causing inflammation, injury to the tissue, and pain
  • 5. INCIDENCE OF LUPUS  Between 500,000 to 1.5 million Americans have lupus.  80-90% of lupus patients are female.  80% of lupus patients are between 15 and 45 years of age.  Lupus affects more African Americans, Asian Americans, Hispanics, and Native Americans than Caucasians.
  • 6. WHAT CAUSES LUPUS? Genetics Hormones Environment
  • 7. Etiology  The specific cause is unknown  Genetic factors may play a role  Environmental agents  Drugs or other chemical agents  Dietary factors  Ultraviolet radiation  Infectious agents
  • 8. LUPUS IS…  Different for each person.  A disease that ranges from mild to life threatening.  Characterized by flares and remissions.
  • 9. TYPES OF LUPUS  Discoid or Cutaneous Lupus (DLE)  Drug Induced Lupus (DIL)  Neonatal Lupus  Systemic Lupus Erythematous (SLE)
  • 10. DISCOID LUPUS  Affects the skin, hair or mucous membranes.  Identified by a rash or lesions.  Diagnosed by biopsy of rash.  10% will evolve into SLE.  Treatment includes topical or interlesional steroids; antimalarials.
  • 13. DRUG INDUCED LUPUS  Develops after long-term use of certain medications.  Most common in men over 50 years old.  Symptoms are similar to SLE.  Most important treatment is to recognize medication and discontinue use.  Once medication is stopped, symptoms usually disappear completely within 6 months.
  • 14. NEONATAL LUPUS  Occurs when the mother’s antibodies cross over the placenta to the baby.  Can affect the skin, heart, liver and/or blood of the fetus and newborn.  Good prenatal care can prevent most problems.
  • 15. SYSTEMIC LUPUS ERYTHEMATOSUS  Can affect any organ in the body including the joints, skin, lungs, heart, blood, kidney, or nervous system.  Can range from mild to life threatening.  No two people will have identical symptoms.
  • 16. COMMON SYMPTOMS OF SLE  Achy joints  Fever  Fatigue  Skin Rashes
  • 17. OTHER LUPUS SYMPTOMS  Chest pain  Headache  Hair loss  Dizziness  Mouth sores  Depression  Photosensitivity  Seizures  Anemia  Memory disturbances  Repeated miscarriages
  • 18. ORGAN INVOLVEMENT WITH LUPUS  Kidneys  Blood vessels  Lungs  Blood  Central nervous  Heart system
  • 19. DIAGNOSING LUPUS  Medical history (including family history)  Complete physical examination  Laboratory tests  Skin or kidney biopsy
  • 20. ACR DIAGNOSTIC CRITERIA Skin criteria Systemic criteria 1. Butterfly rash 5. Arthritis 2. Discoid rash 6. Serositis 3. Photosensitivity 7. Kidney disorder 4. Oral ulcers 8. Neurologic disorder Laboratory criteria 9. Hematologic abnormalities 10. Immunologic disorder 11. Antinuclear antibody
  • 21. Criterion Definition Malar Rash Rash over the cheeks Discoid Rash Red raised patches DIAGNOSIS resulting in the development of or increase Photosensitivity Reaction to sunlight, in skin rash Oral Ulcers Ulcers in the nose or mouth, usually painless Arthritis Nonerosive arthritis involving two or more peripheral joints (arthritis in which the bones around the joints do not become destroyed) Serositis Pleuritis or pericarditis (inflammation of the lining of the lung or heart) Renal Disorder Excessive protein in the urine (greater than 0.5 gm/day or 3+ on test sticks) and/or cellular casts (abnormal elements the urine, derived from red and/or white cells and/or kidney tubule cells)
  • 22. Criterion Definition Neurologic Seizures (convulsions) and/or psychosis in the absence of Disorder drugs or metabolic disturbances which are known to cause DIAGNOSIS such effects Hematologic Hemolytic anemia , leukopenia , lymphopenia or Disorder thrombocytopenia. The leukopenia and lymphopenia must be detected on two or more occasions. The thrombocytopenia must be detected in the absence of drugs known to induce it. Antinuclear Positive test for antinuclear antibodies (ANA) in the absence Antibody of drugs known to induce it. Immunologic Positive anti-double stranded anti-DNA test, positive anti-Sm Disorder test, positive antiphospholipid antibody such as anticardiolipin, or false positive syphilis test (VDRL). Adapted from: Tan, E.M., et. al. The 1982 Revised Criteria for the Classification of SLE. Arth Rheum 25: 1271-1277.
  • 26. Systemic Lupus Erythematosus  Head and Neck Manifestations  Malar rash first sign in 50%  Erythematous maculopapular eruption after sun exposure  Oral ulceration
  • 27. Musculoskeletal System  All joints can be affected, however the wrists, knees, ankles, elbows, and shoulders are most common
  • 28. Musculoskeletal System (Cont.)  Hand deformities can include ulnar deviation and subluxation, swan neck deformities, and subluxation of thumb interphalangeal joints  Reversible subluxation has been observed in the knees
  • 31. Cardiovascular System  Pericarditis is the most common cardiac manifestation  myocarditis  Endocarditis with characteristic lesion of the cardiac valve
  • 32. Pulmonary System  Pleurisy is the most common manifestation of pulmonary involvement  Interstitial lung disease  Pulmonary embolisms
  • 33. Gastrointestinal Sytem  Difficulty swallowing  Gastric reflux disease  Anorexia, nausea, or vomiting may be present  Pancreatitis
  • 34. Raynaud’s Phenomena Http://www.dermis.net/doi a
  • 35. Renal manifestations  Tend to appear within the 1st 2yrs of SLE  Almost ½ have asymptomatic urine abnormalities  Proteinuria - dominant feature  Haematuria – almost always present but not in isolation
  • 36. Nervous System  Neuropsychiatric manifestations of lupus occur frequently  May be mild to severe  Any location in the nerve system may be affected (brain, spinal cord, peripheral system)
  • 37. Nervous System (Cont.)  Central Nerve System  Acute confusional state  Psychosis  Anxiety disorder  Headache  Cerebrovascular disease
  • 38. Nervous System (Cont.)  Peripheral Nerve System  Cranial neuropathy  Mononeuropathy  Polyneuropathy
  • 39. COMMON LABORATORY TESTS  Antinuclear Antibody (ANA)  Anti DNA  Anti-Sm  Anti-RNP  Anti-Ro  Anti-La
  • 40. OTHER LABORATORY TESTS  CBC (RBC, WBC, platelets)  Rheumatoid Factor  Urinalysis  Skin biopsy  Sedimentation Rate (ESR)  Kidney Biopsy
  • 41. EFFECT OF LABORATORY TESTS WITH INCREASED LUPUS ACTIVITY C reactive protein (CRP)  Sedimentation rate (ESR) CBC (WBC, RBC,  Anti DNA platelets)  Liver and Kidney Complement Function tests Serum albumin  CPK  Urine protein or cell casts
  • 42. LUPUS TREATMENT  Team effort  Tailored  Tentative
  • 43. LUPUS PHYSICIANS  Family Practitioner  Internist  Rheumatologist  Clinical Immunologist  Dermatologist  Nephrologist  Other specialists
  • 44. COMMON LUPUS MEDICATIONS  NSAIDs  Antimalarials  Corticosteroids  Immunosuppressants  Investigational (research)
  • 45. NSAIDs  Aspirin  Ibuprofen  Indomethacin
  • 46. CORTICOSTEROIDS  Prednisone  Prednisolone  Methylprednisolone  Hydrocortisone
  • 47. ANTIMALARIALS  Chloroquine
  • 48. IMMUNE SUPPRESSANTS  Cyclophosphamide  Azathioprine
  • 49. PREVENTIVE MEASURES  Sun precautions  Rest  Nutrition/diet  Exercise  Moist heat  Prevent infection  Don’t smoke
  • 50. Th a n k Y o u

Editor's Notes

  1. It is estimated that between 500,000 to 1.5 million Americans have lupus. More than 16,000 Americans develop lupus each year. Both men and women can get lupus, however, lupus is 10-15 times more common in females than males. 80-90% of lupus patients are female. Although children, teenagers and the elderly can get lupus, it most commonly affects women of childbearing years between the ages of 22 and 40. 80% of lupus patients are between 15 and 45 years of age. Lupus disproportionately affects African Americans, Asian Americans, Hispanics, and Native Americans. African American women are 3 times more likely than Caucasian women to be affected by lupus.
  2. Lupus is an extremely complex disease, and although scientists are making progress in understanding the causes of lupus, there is still no single known cause. It is thought that a combination of genetics, environment, and possibly hormones act together to trigger the disease. Genetics: There is considerable evidence indicating that genes play a major role in the disease process. Researchers believe that there may be as many as 100 genes, which contribute to the genetic predisposition and development of SLE, and they have recently discovered a single gene that causes a lupus-like illness in mice. Hormones: The effect of hormones in humans with lupus is not clear. However, because the majority of lupus patients are women in their childbearing years, it seemed a logical aspect to study. Female hormones tend to stimulate the immune system or promote an immune response, (remember that having lupus means having an overactive immune system), whereas male hormones have the opposite effect and are more immunosuppressive. There does not seem to be any evidence that men or women with lupus produce abnormal levels of hormones, however, there may be differences in the way people with lupus process these hormones. Environment: Although it has not yet been fully proven, there may be certain environmental factors that play a role in initiating or triggering lupus in a genetically predisposed person.
  3. Since lupus can attack any organ or organ system in the body, it affects everyone differently and there are no two cases that are alike. It can range from mild to life threatening and anywhere in between. People with lupus generally go through periods of flares , which are sudden increases in disease activity or development of new symptoms, and remissions, which are periods of disease-free activity.
  4. The term "lupus" is commonly used when talking about any form of the disease. When someone says, "I have lupus," he or she could be affected in many different ways depending on the type of lupus present. Even within the same type of lupus, each case is different. The different types of lupus include: ·         Discoid or Cutaneous Lupus (DLE) ·         Drug Induced Lupus (DIL) ·         Neonatal Lupus ·         Systemic Lupus Erythematous (SLE)
  5. Discoid or Cutaneous lupus (skin) lupus (DLE) : affects primarily the skin, but may also involve the hair and mucous membranes . There is more than one type of cutaneous lupus, which can cause different looking rashes and symptoms. These include: Acute cutaneous lupus erythematosus (ACLE) Subacute cutaneous lupus erythematosus (SCLE) Chronic cutaneous lupus erythematosus (CCLE) or Discoid lupus erythematosus (DLE) Cutaneous lupus is usually identified by a rash or lesions that appear on the face, neck, and/or scalp (or other sun exposed areas). The lesions can appear patchy, crusty and cause scarring. Cutaneous lupus does not generally involve the body's internal organs. Therefore, the ANA test , which is a blood test used to help diagnose systemic lupus, may be negative in these patients. However, in some patients with discoid lupus, the ANA test is positive, but at a low level or "titer ." Cutaneous lupus is diagnosed by examining a biopsy of the skin rash . In approximately 10 percent of patients, cutaneous lupus will evolve into the systemic form of the disease . This cannot be predicted or prevented. Treatment of cutaneous lupus will not prevent its progression to the systemic form, and individuals who progress to the systemic form probably had systemic lupus with the rash as their initial symptom. Topical and interlesional corticosteroids are usually effective for localized lesions , antimalarials or thalidomide may be needed for more generalized lesions.
  6. Although the exact cause is unknown, Drug Induced Lupus can develop after long-term use of certain medications . It is most common in men over 50 years of age (because they are given the offending drugs more often). The symptoms of drug-induced lupus are similar to those of systemic lupus and are mild in most people, but can become debilitating if the person continues to take the offending medication. It usually takes several months to years of continuous therapy with the medication before symptoms appear. Once the suspected medication is stopped, symptoms should go away within days. Usually symptoms disappear within one or two weeks and the symptoms usually disappear completely within six months . The antinuclear antibody test (ANA) may stay positive for years .   At least 38 drugs currently in use can cause DIL . However, most cases have been associated with the following: Hydralazine (Apresoline) Procainamide (Procan, Pronestyl) Methyldopa (Aldomet) Quinidine (Quinaglute) Isoniazid (INH) Some anti-seizure medications such as phenytoin (Dilantin) or carbamazepine (Tegretol)   The most important aspect of treating drug-induced lupus is to recognize the medication that is causing the problem and discontinue its use . This step is often sufficient to improve the symptoms within a few days. Individuals sometimes improve more quickly if non-steroidal anti-inflammatory drugs (NSAIDs) are then used and corticosteroids may be used for patients with severe symptoms of DIL.
  7. Neonatal lupus is not SLE or Cutaneous lupus . Neonatal lupus occurs when the mother’s antibodies cross over the placenta to the baby . This can affect the skin, heart, liver and/or blood of the fetus and newborn . It is associated with a rash that appears within the first several weeks of life and may persist for about six months before disappearing. Some babies with neonatal lupus may have a serious heart defect called congenital heart block . This disorder can usually be controlled by placing a pacemaker in the baby . Congenital heart block is much less common than the skin rash. Early detection and treatment is vital in achieving a positive outcome for the baby and because doctors can now identify most at risk patients, neonatal lupus is very rare and most infants of mothers with SLE are entirely healthy.
  8. Systemic lupus erythematosus (SLE) can affect any system or organ in the body including the joints, skin, lungs, heart, blood, kidney, or nervous system . Symptoms of SLE can range from being minor to very serious or life threatening . A person may experience very little to no pain or they may experience extreme pain, especially in the joints. There may be no skin involvement or rashes that are disfiguring. They may have no organ involvement or extreme organ damage. Generally, no two people with systemic lupus will have identical symptoms . Most often when people mention "lupus," they are referring to the systemic form of the disease.
  9. Although SLE can affect any part of the body, most people experience symptoms in only a few organs. Common symptoms include painful or swollen joints, unexplained fever, skin rashes , and extreme fatigue . A characteristic skin rash--the butterfly rash may appear across the nose and cheeks. Other rashes occur elsewhere on the face and ears, upper arms, shoulders, chest, and hands.
  10. Other symptoms of lupus include chest pain , hair loss, mouth sores, sensitivity to the sun , anemia (a decrease in red blood cells), and pale or purple fingers and toes from cold and/or stress (Raynaud’s phenomenon). SLE patients can also experience repeated miscarriages, headaches, dizziness, depression, seizures, cognitive dysfunction and/or memory disturbances. New symptoms may continue to appear years after the initial diagnosis, and different symptoms can occur at any time during a person’s lifetime.
  11. In many people with lupus, only one system of the body such as the skin or joints is affected. Other people experience symptoms in many parts of their body. Just how seriously a body system is affected can also vary from person to person. The following systems in the body can be affected by lupus: Kidneys Lungs Central nervous system Blood vessels Blood Heart
  12. Because lupus symptoms can come and go, are usually vague and often mimic other illnesses, it can be a very difficult disease to diagnose. It may take months or even years for doctors to piece together the symptoms to diagnose this complex disease. The onset of lupus may be acute, resembling an infectious process consisting of fever, pleurisy and muscle aches or it may be a progression of vague symptoms over a long period of time. Because there is no one single test that can tell if a person has lupus, diagnosis is usually made by a careful review of a person’s entire medical history (including family history), complete physical examination, and analysis of laboratory tests. Sometimes a biopsy of the skin or kidney may be used to help with the diagnosis. The symptoms described by the patient may appear to be totally unrelated; therefore an open mind and good communication is necessary when assessing the patient.
  13. To assist the physician in the diagnosis of lupus, the American College of Rheumatology (ACR) has developed a set of classification criteria used to help distinguish lupus from other diseases. A person should have four or more of these symptoms to suspect lupus. It is important to remember that the symptoms do not have to occur at the same time, and the criteria do not include all possible symptoms of lupus like fever, fatigue, hair loss, or Raynaud's phenomenon. The criteria are meant only to help with diagnosis. Butterfly or Malar Rash Rash over the cheeks and/or nose. Discoid Rash Red raised patches anywhere on the skin, but usually in the sun exposed areas of the face, arms, neck, hands. Photosensitivity Reaction to sunlight, resulting in the development or increase in skin rash or general feeling of illness. Oral Ulcers Ulcers in the nose or mouth, usually painless. Arthritis Non-erosive arthritis involving two or more peripheral joints (arthritis in which the bones around the joints do not become destroyed). Serositis Pleuritis or pericarditis – pain in the chest with deep breathing. Renal Disorder Excessive protein and/or cellular casts (abnormal elements the urine, derived from red and/or white cells and/or kidney tubule cells) in the urine. Neurologic Disorder Seizures (convulsions) and/or psychosis. Hematologic Disorder Hemolytic anemia (low red blood cell count), leukopenia (low white blood cell count) or thrombocytopenia (low platelet count). Immunologic Disorder Positive LE prep test, positive anti-DNA test, positive anti-Sm test or false positive syphilis test (VDRL). Antinuclear Antibody Positive test for antinuclear antibodies.
  14. No single test can determine whether a person has lupus, but several laboratory tests may help the doctor to make a diagnosis. The most useful tests identify certain autoantibodies often present in the blood of people with lupus. Initial screening usually includes the antinuclear antibody test (ANA). This test is positive in 95-98% of people with lupus. However, just because a person has been told they have a positive antinuclear antibody test (ANA), does not mean they have lupus. The ANA is NOT a lupus test. It is only a test that points the doctor in several different directions. People with other rheumatic diseases and healthy relatives of people with autoimmune diseases can also have a positive ANA. It can also become positive with many other things like aging, pregnancy, viral infections and also as the result of taking certain medications. About 10 million Americans have a positive ANA and only about 1 million of them have SLE. If three or more clinical features, such as skin, joint, kidney, pleural, pericardial, hematological, or central nervous system findings are present, a positive test can confirm the disease. Anti-DNA- Are present in about 60-80% of patients with active SLE. The test is highly specific for SLE and not found in patients with other rheumatic diseases. It is also associated with a greater risk of lupus nephritis. Anti-Sm- Are present in about 30% of lupus patients. This test is highly specific for patients with SLE and rarely found with other rheumatic diseases. It is often used to confirm a lupus diagnosis. Anti-RNP is seen in SLE and mixed connective tissue disease. Anti-Ro(SSA) and Anti-La(SSB)- Anti-Ro is found in about 30% of SLE patients. It is also highly associated with photosensitivity. Anti-La is found in about 15% of lupus patients. Both of these are almost always found in babies who are born with neonatal lupus. They are also present in people with subacute cutaneous lupus, and Sjögren’s Syndrome.
  15. Other laboratory tests that may be helpful include: CBC/Complete blood count- RBC/Red blood count - About 40% of patients with SLE will have problems with their RBC’s (anemia), which may be caused by iron deficiency, GI bleeding, medications or autoantibody formation to RBC’s. WBC/White blood count - About 15-20% of lupus patients have a decrease in WBC’s (leukopenia). Platelets - About 25-35% of patients with lupus have low platelets (thrombocytopenia). Urinalysis: There is no one test to tell if there is lupus disease in the kidneys. A doctor can test for kidney problems by using urine tests, kidney function tests, blood tests and/or x-rays. If red blood cells, protein and/or cell casts (fragments of dead cells from blood cells or the kidney tubes themselves) are found in a urinalysis, it may mean that the kidney is not working correctly or that there is major damage to the kidneys. In these cases, further testing may need to be done. Blood Chemistry : tests are important, especially the creatinine and urea which are raised if there has been evidence of kidney disease. ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) - These tests frequently rise with generalized inflammation. The levels are usually increased with patients who have active lupus and decrease with corticosteroid or NSAID use. Antiphospholipid Antibodies - These tests are associated with the problem of 'sticky blood'. Patients with high levels of antiphospholipid antibodies have an increased tendency to clotting or thrombosis, both in the veins and arteries, and in pregnant women with this condition, there is a risk of thrombosis leading to miscarriage. The most widely measured are the lupus anticoagulant and the anticardiolipin antibody. Rheumatoid factor is positive in 20-30% of SLE patients and 80% of Rheumatoid Arthritis patients. High levels of rheumatoid factor with low levels of ANA are more indicative of RA and not SLE. It is also seen in people with Sjögren’s Syndrome. Complement (C-3, C-4 and CH50)- If the total blood complement level is low, or the C3 or C4 values are low and the person also has a positive ANA, some weight can be added to the diagnosis of lupus. Low C3 and C4 levels in patients with a positive ANA may show the presence of active disease, especially kidney involvement. Syphilis test (VDRL or RPR)- This test may be falsely positive in lupus patients. Biopsy or tissue sample- Can be helpful in making a diagnosis and also helps to evaluate organs. The most common sites are the skin and kidney. The doctor removes a small piece of tissue and looks at it under a microscope. All of these tests serve as tools to give the doctor clues and information in making a diagnosis. The doctor will look at the entire picture--medical history, symptoms, and test results--to determine if a person has lupus.
  16. An increase in lupus activity usually causes the following test results to rise CRP, sed rate, anti DNA, liver and kidney function tests (AST, ALT, BUN, Creatinine- with kidney or liver involvement), CPK (if muscle involvement is present), urine protein or cellular casts. An increase in lupus activity usually causes the following test results to fall: CBC (WBC, RBC, platelets), complement, serum albumin.
  17. At present, there is no cure for lupus; however, the symptoms can be minimized with proper treatment. In developing a treatment plan, the doctor has several goals: to prevent flares, to treat flares when they do occur, and to minimize organ damage and other complications. The variations and effectiveness of treatments for lupus have increased tremendously and doctors have many more choices when treating the disease. Lupus treatment is a team effort between the patient and their physician(s). The patient should work closely with the doctor and take an active role in treatment. Good communication between everyone is extremely important. Because there are no two cases of lupus that are alike, the treatment must be tailored to the specific needs and symptoms of each person. Once lupus has been diagnosed, the doctor will develop a treatment plan based on the patient’s age, sex, health, symptoms, and lifestyle. The treatment will also be tentative and probably change over time. Ongoing medical supervision is essential to ensure that proper care is given as the course of the disease changes. The doctor and patient should reevaluate the plan regularly to ensure that it remains as effective as possible.
  18. Diagnosing and treating lupus is often a team effort between the patient and several types of health care professionals. Most people usually seek the help of their Family Practitioner or Internist first, which is often sufficient. However, when unresolved questions or more complicated symptoms arise, an opinion from a specialist may be necessary. The choice of specialist(s) depends on the organ or organs involved. For example, a Dermatologist is usually seen for skin problems, and a Nephrologist for kidney problems. Most often, a Rheumatologist or Clinical Immunologist specializing in lupus or immune system disorders is recommended.
  19. Medications play an important role in the care of people with SLE. For most people with lupus, effective treatment can minimize symptoms, reduce inflammation, and maintain normal body functions. Treatment approaches are based on the specific needs and symptoms of each person. The medication prescribed usually depends on which organ(s) are involved and the severity of the involvement. The choice of drugs is highly individualized and typically changes often during the course of the disease. The medications used in the management of lupus include: ·         NSAIDs ·         Antimalarials ·         Corticosteroids ·         Immunosuppressants ·        Investigational (research)
  20. NSAIDs are prescribed either alone or in combination with other types of drugs to reduce the inflammation responsible for the pain and discomfort associated with lupus. Common side effects of NSAIDs can include stomach upset, heartburn, diarrhea, and fluid retention. Some patients with lupus also develop liver and kidney inflammation while taking NSAIDs, making it especially important to stay in close contact with the doctor while taking these medications. Examples include: ·         Aspirin ·         Ibuprofen (Motrin, Advil) ·         Naproxen (Naprosyn) ·         Indomethacin (Indocin) ·         Nabumetone (Relafen) A new class of anti-inflammatory drugs called COX-2 inhibitors (celecoxib [Celebrex]; rofecoxib [Vioxx]; work like NSAIDs on pain and inflammation but have a much lower risk of gastrointestinal side effects.
  21. Corticosteroids (steroids) are hormones that have very potent anti-inflammatory properties. They are normally produced in small quantities by the body. Prednisone, prednisolone, methylprednisolone, and hydrocortisone are man- made or synthetic steroids. They are an important part of lupus therapy because they work well at suppressing the immune system and reducing inflammation. Unfortunately, long term use of steroids can cause serious side effects such as avascular necrosis, osteoporosis, coronary artery disease, muscle weakness, thinning of the skin, elevated blood sugar, increased appetite, cataracts, glaucoma, depression, mood swings, hypertension and increased susceptibility to infections. It can be dangerous to stop taking corticosteroids suddenly, so it is very important that the doctor and patient work together anytime the dose is changed. Sometimes doctors give very large doses of IV corticosteroids over a brief period of time. This is called “bolus" or "pulse" therapy. With this treatment, the typical side effects are less likely and slow withdrawal is not necessary.  
  22. Antimalarial drugs such as Chloroquine and Plaquenil are commonly used in the management of lupus symptoms. These drugs were originally used to treat malaria, but doctors found that they are also beneficial for lupus patients. It is not exactly clear how antimalarials work, but researchers believe that they may suppress parts of the immune response, reducing inflammation. They are prescribed for fatigue, lupus arthritis, mouth ulcers and skin manifestations. It may take months before these drugs demonstrate beneficial effects. Antimalarials are usually tolerated well. Side effects are rare, and consist of occasional diarrhea or rashes. High dose therapy may damage the retina of the eye, causing vision problems. Eye examinations are, therefore, required every six to twelve months. With the low doses of anti-malarials used in the treatment of lupus, the risk of eye complications are extremely low. Clinical studies show that continuous treatment with antimalarials may prevent lupus flares from recurring.
  23. Cytoxan, Imuran, methotrexate, and Leukeran are in a group of agents known as cytotoxic or immunosuppressive drugs. These medications are used to suppress the immune system in patients with more serious lupus manifestations such as lupus nephritis and neurologic disease in whom treatment with corticosteroids has failed. Side effects can be serious and include gastrointestinal complications, alopecia, increased risk for infections, sterility, hemorrhagic cystitis, bladder fibrosis, and possibly cancer. Researchers are looking into using combination therapies such as cyclophosphamide and prednisone for lupus nephritis. It is more effective in preserving renal function than prednisone alone an can reduce the likelihood of end-stage renal failure.
  24. In combination with medications, there are preventive measures which can help to reduce the risk of lupus flares. Photosensitivity is an abnormal reaction to UV rays and results in exacerbation of lupus symptoms. About 1/3 of lupus patients are photosensitive and should avoid prolonged direct exposure to the sun. All patients should use sun precautions and apply a sunscreen with an SPF 15 or greater; avoid sun exposure between 10 a.m. and 4 pm and wear protective clothing and wide-brimmed hats. Fluorescent and halogen lights can also emit UV rays, which can aggravate lupus. There are plastic light shields available that block UV emissions. The fatigue found in lupus can be an overwhelming and debilitating symptom therefore proper and adequate rest is vital in dealing with the disease. Some patients require a nap during the day as well as 8 to 10 hours of sleep at night. Lupus patients also need to learn how to alternate activities with periods of rest. Staying in bed can cause weakness, but overdoing it can cause lupus to flare.   Nutrition and a well-balanced diet are also essential components to successfully living with a chronic disease like lupus.  There is no "lupus diet." People with lupus should eat well-balanced meals that are low in fat, low in salt, high in fiber and low in sugar. People on corticosteroids (Prednisone) should limit their sugar, fat and salt. A restricted diet may be prescribed when hypertension, kidney disease, edema or diabetes is present. Nutritional counseling may also be beneficial to some people. If you find that certain foods make you feel bad or cause a "flare-up" of your lupus, you should avoid those foods. Lupus patients are encouraged to do low impact exercise as tolerated. This can prevent muscle weakness and fatigue. Walking, stretching, range of motion, swimming, low impact aerobics and bicycling can help keep you strong and prevent thinning of bones or osteoporosis . Remember to alternate your activities with rest periods. Be careful of doing heavy weight lifting or high impact exercises as this may make your lupus worse. If you feel overly tired or have increased discomfort for more than two hours after exercising, the session was probably too much and the next session should be made shorter. Moist heat is better for aching joints than dry heat. Soaking in a tub, Jacuzzi or taking a warm shower can help make your joints feel better. The time to use ice and/or cold packs is within 36 hours of an injury. Moist heat and topical analgesic cremes are usually beneficial for muscle and joint pain but should be approved by the patient’s physician. Call your doctor if your temperature is over 99.6. It could be an infection or a lupus flare. Smoking is detrimental to anyone’s health, especially those suffering from chronic disease. Cigarette smoke contains chemicals, which can cause flares of cutaneous lupus. It can make symptoms of Raynaud's disease worse by impairing circulation (blood flow), and there can also be stomach problems from medications in people who use tobacco.