Systemic Lupus Erythematosus

Systemic Lupus Erythematosus 

Autoimmune disease characterized by autoimmune antibodies espesially antinuclear antibodies ANA. 

lupus and Dr. House XD

SYMPTOMS:

• Chest pain when taking a deep breath
• Fatigue
• Fever with no other cause
• General discomfort, uneasiness, or ill feeling (malaise)
• Hair loss
• Mouth sores
• Sensitivity to sunlight
• Skin rash -- a "butterfly" rash over the cheeks and bridge of the nose affects about half of people with SLE. The rash gets worse in sunlight. It's called: Malar erythema.
• Swollen lymph nodes
  Other symptoms depend on what part of the body is affected:
  • Brain and nervous system: headaches, numbness, tingling, seizures, vision problems, personality changes
  • Digestive tract: abdominal pain, nausea, and vomiting
  • Heart: abnormal heart rhythms (arrhythmias)
  • Lung: coughing up blood and difficulty breathing
  • Skin: patchy skin color, fingers that change color when cold (Raynaud's phenomenon)
  Some patients only have skin symptoms. This is called discoid lupus.
  
  
  
  
  
  
  Malar erythema
  
  

  Criterion	Definition
  1.    Malar rash	Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds
  2.    Discoid rash	Erythematous raised patches with adherent keratotic scaling and follicular plugging; atrophic scarring may occur in older lesions
  3.    Photosensitivity	Rash as a result of unusual reaction to sunlight, by patient history or physician observation
  4.    Oral ulcers	Oral or nasopharyngeal ulceration, usually painless, observed by a physician
  5.    Arthritis	Nonerosive arthritis involving two or more peripheral joints, characterized by tenderness, swelling, or effusion
  6.    Serositis	Pleuritis—convincing history of pleuritic pain or rub heard by a physician or evidence of pleural effusion, or
  	Pericarditis—documented by electrocardiogram or rub or evidence of pericardial effusion
  7.    Renal disorder	Persistent proteinuria >0.5 gm/dL or >3 if quantitation not performed or
  	Cellular casts—may be red blood cell, hemoglobin, granular, tubular, or mixed
  8.    Neurologic disorder	Seizures—in the absence of offending drugs or known metabolic derangements (e.g., uremia, ketoacidosis, or electrolyte imbalance), or
  	Psychosis—in the absence of offending drugs or known metabolic derangements (e.g., uremia, ketoacidosis, or electrolyte imbalance)
  9.    Hematologic disorder	Hemolytic anemia—with reticulocytosis, or
  	Leukopenia—<4.0 × 109 cells/L (4000 cells/mm3) total on two or more occasions, or
  	Lymphopenia—<1.5 × 109 cells/L (1500 cells/mm3) on two or more occasions, or
  	Thrombocytopenia—<100 × 109 cells/L (100 × 103 cells/mm3) in the absence of offending drugs
  10.  Immunological disorder	Anti-DNA antibody to native DNA in abnormal titer, or
  	Anti-Sm—presence of antibody to Sm nuclear antigen, or
  	Positive finding of antiphospholipid antibodies based on (1) an abnormal serum level of IgG or IgM anticardiolipin antibodies, (2) a positive test for lupus anticoagulant using a standard test, or (3) a false-positive serologic test for syphilis known to be positive for at least 6 months and confirmed by negative Treponema pallidum immobilization or fluorescent treponemal antibody absorption test
  11.  Antinuclear antibody	An abnormal titer of antinuclear antibody by immunofluorescence or an equivalent assay at any point in time and in the absence of drugs known to be associated with drug-induced lupus syndrome

  
  
  
  
  
  # Kidney
  A morphologic classification of lupus nephritis has proven to be clinically useful.^[81] Five patterns are recognized: 
  
  
  # minimal mesangial (class I);
  # mesangial proliferative (class II); 
  # focal proliferative (class III); 
  # diffuse proliferative (class IV); 
  # and membranous (class V). 
  
  
  
   Lupus nephritis. A, Focal proliferative glomerulonephritis, with two focal necrotizing lesions at the 11 o'clock and 2 o'clock positions (H&E stain). B, Diffuse proliferative glomerulonephritis. Note the marked increase in cellularity throughout the glomerulus (H&E stain). C, Lupus nephritis showing a glomerulus with several "wire loop" lesions representing extensive subendothelial deposits of immune complexes (periodic acid-Schiff stain). D, Electron micrograph of a renal glomerular capillary loop from a patient with SLE nephritis. Subendothelial dense deposits correspond to "wire loops" seen by light microscopy. E, Deposition of IgG antibody in a granular pattern, detected by immunofluorescence. B, basement membrane; End, endothelium; Ep, epithelial cell with foot processes; Mes, mesangium; RBC, red blood cell in capillary lumen; US, urinary space; *, electron-dense deposits in subendothelial location.
  
  
  
  
  
  
  

  Histopathology Kidney --Systemic lupus erythematosus

  
  
  
  

  Rheumatology Ch3 04 Systemic Lupus Erythematosus