Systemic Lupus Erythematosus Part II Authors Eric W

Systemic Lupus Erythematosus Part II Author(s): Eric W. Orlowsky, MD Level: Basic Academic Affiliation : Division of Rheumatology Duke University Medical Center Version No: 1. 2 Submitted: February 2012 Editors’ Review: December 2013

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3 Financial Disclosures (past 3 years) No Disclosures

4 Learning Objectives • To recognize the various clinical manifestations of SLE • To talk briefly about treatments • To review diagnostic criteria for SLE • To talk about special cases – Lupus in Pregnancy – Drug-Induced Lupus

5 Outline (Parts I and II) I. Epidemiology II. Pathophysiology III. Clinical Presentations IV. Classification Criteria V. Special Situations

6 Classificaiton Criteria for SLE (4 of 11) Anti-Nuclear Ab (ANA) Malar Rash Immune Ab Discoid Rash – Anti-ds. DNA – Anti-Smith – Antiphosolipids Hematologic Disorder – Hemolytic Anemia – Leukopenia – Lymphopenia Photosensitivity Oral/Nasal Ulcers Arthritis Nephritis Serositis Neurologic Disorder

7 Malar Rash (Canis Lupus= Wolf) “Butterfly Rash” Only 30 to 60% Waxes and wanes

8 Discoid Rash Disfiguring scar Better prognosis Only 15 to 30%

9 Mucocutaneous Ulcers • Oral or nasopharyngeal • Painless • Physician observed

10 Arthritis • Non-erosive • Reducible – Increased joint laxity • “Jaccoud’s Arthropathy”

11 Nephritis • Criteria: – >0. 5 mg proteinuria – (2+ on dipstick) – Cellular casts on UA RBC, granular casts • Half to 2/3 patients • Renal biopsy guides Rx

12 Serositis Only 25 to 30% Lungs – Pleural effusions Heat – Pericardial effusions

13 Neuropsychiatric • Criteria – Seizures – Psychosis • Cognitive Impairment • Demyelinating disorders

14 Special Cases: Neonatal Lupus • Mother-Anti-Ro + • Antibody crosses placenta • at risk for congenital heart block

15 Special Cases: Drug-Induced Lupus • Rash and arthritis • Medications – – Hydralazine/Methyldopa Minocycline Procainamide/Quinidine TNF inhibitors • ANA positive – Anti-histone Pattern – Improves with removal of offending agent

16 Summary • Diagnosis needs 4 of 11 criteria • Babies of mothers with Anti-Ro antibodies are at risk for neonatal lupus • Drug-induced Lupus: anti-histone ANA & usually selflimited with stopping medication

17 Key References • American College of Rheumatology. www. rheumatology. org [website accessed 2/18/12]. • Hochberg, MC et al. Rheumatology. 5 th ed. Elsevier: 2011 (Philadelphia). • Klippel, JH et al. Primer on the Rheumatic Diseases. 13 th ed. Arthritis Foundation. • Le, TH et al. First Aid for the USMLE Step 3. • Wikimedia Commons. http: //commons. wikimedia. org/ [website accessed 2/23/12].

18 Acknowledgements • Dr. Lisa Criscione-Schreiber • Faculty & Staff of Duke Rheumatology • All my former patients and teachers

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