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DoctorNaLi
BinzhoumedicalcollegeYantaiaffiliatedhospital
SLE
Autoimmunediseasethataffectsmultisystems
Prevalenceof17to48per100,000population
Women>Men-9:1ratio
90%casesarewomen
AfricanAmericans>Whites
Onsetusuallybetweenagesof15and45years,but
Canoccurinchildhoodorlaterinlife
ClinicalManifestations
Forthepurposeofidentifyingpatientsinclinicalstudies,apersonhasSLEif4ormoreofthe11criteriaarepresent,seriallyorsimultaneously,duringanyintervalofobservation.(specificity95%,sensitivity75%)
ItisimportanttorememberthatapatientmayhaveSLEandnothave4criteria.
Cutaneous
Mostcommonrashisphotosensitive,-85%developatsomepointindisease
DiscoidLupusErythematosus(DLE):15-30%circular,scalyhyperpimentedlesionswitherythematousrim,atrophiccenter—canbedisfiguring
Mouth/vaginal/nasalulcers
Alopecia:%
MalarRash
DiscoidRash
MSK
Polyarthritis,mildtodisabling,occursmostfrequentlyinhands,wrists,%
Jointdeformitiesoccurinonly10%
ArthritisofSLEtendstobetransitory
Ifsinglejointhaspersistentpain,considerosteonecrosis(prevalenceincreasedinSLEovergeneralpopulation,especiallyifonsteroids.)
MyositiswithelevatedCKandweaknessrarelyoccurs
Arthritis
Serositis-Pulmonary
Pleuritiswithorwithouteffusion
-ifcaseismild,tx:NSAIDS
-ifcaseissevere,tx:steroids
Life-threateningmanifestations:interstitialinflammationwhichcanleadtofibrosisandintra-alveolarhemorrhage.
AlsopneumothoraxandpulmonaryHTNcanoccur
Neuro
Cranialorperipheralneuropathyoccursin10-15%,itisprobablysecondarytovasculitisinsmallarteriessupplyingnerves.
DiffuseCNSdysfunction:memoryandreasoningdifficulty
Headache:ifexcruciating,oftenindicateacuteflare
Seizuresofanytype
Psychosis:mustdistinguishfromsteroid-inducedpsychosis(occursin1stweeksoftxatdoses≥40mgprednisoneandresolvesafterseveraldaysofreducingorstoppingtx)