Systemic Lupus Erythematosus

Question 1

Systemic Lupus Erythematosus (SLE)

Answer 1

An autoimmune disorder characterized by the production of autoantibodies

(An autoantibody is an antibody produced by the immune system that is directed against one or more of the individual’s own proteins)

Most common form of LUPUS

Presents with episodes of remission and relapse

Question 2

S/S: Systemic

(3)

Answer 2

1. Malaise
2. Fever
3. Fatigue

Constitutional S/S

Question 3

S/S: Skin & Hair

(3 + 1)

Answer 3

1. Malar rash
   “Butterfly rash” ~ around the malar eminence - upper cheeks
2. Discoid rash
   Raised, red rashes that can lead to scarring
   Ex. Singer SEAL
3. Photosensitivity
   Rash as a result of UV exposure (sun)
   ** May affect the modalities used
4. Alopecia - hair loss

Question 4

S/S: Mucous Membrane

Answer 4

Oral or nasopharyngeal ulcers

Question 5

S/S: Pulmonary

Answer 5

Pleuritic chest pain & SOB
- as a result of positioning & DB

Question 6

S/S: Cardiovascular

(3)

Answer 6

1. Pericarditis
2. Hypertension
3. Raynaud’s
   - RA = 1/3 of patients
   - Mindful of what modalities to use

Question 7

S/S: Hematological

(2)

Answer 7

1. Amenia - low RBC
2. Coagulation disorders (low platelet)
   May bruise easily or have uncontrolled bleeding

Question 8

S/S: Neuropsychiatric

(3)

Answer 8

1. Headaches
2. Seizures
3. Psychosis
   Especially, in the absence of recreational drugs OR metabolic diseases OR medications

Question 9

S/S: Renal

Answer 9

1. Proteinuria
2. Cellular (urinary) casts
   Urinary casts may be made up of white blood cells, red blood cells, kidney cells, or substances such as protein or fat.

Question 10

S/S: MSK

Answer 10

1. Nonerosive Arthritis
   Symmetrical
   Tenderness or effusion
   Commonly in peripheral joints (except hips)
   Spine & hips usually not involved
2. Hand deformities (much less common than in Ra = ~10%)
   No joint space narrowing or erosion (like in RA)
   Deformities caused by tendon & ligament laxity = true laxity

NO nodules in SLE

Question 11

1982 American College of Rheumatology (ACR) Criteria for Classification of SLE

Symptoms & Description (11)

Acronym

Answer 11

Developed for classification for scientific research, but adopted by physicians
A person with > 4 of 11 symptoms is classified with having SLE

SOAP BRAIN MD

1. Serositis - Pleuritis OR pericarditis
   Chest pain w/ DB or moving positions
2. Oral Ulcers - ulcers in mouth or nose
   ** Anything in the mucus membrane - can be painful or not
3. Arthritis - nonerosive arthritis involving 2 or more peripheral joints w/ tenderness or effusion
4. Photosensitivity - skin rash with UV light exposure (ex. sunlight)
   Very characteristic of SLE
5. Blood Disorders - Low RBC or WBC or platelets
6. Renal disorder - persistent proteinuria or cellular casts
7. ANA +ve - Hallmark lab value
   ANA = anti-nuclear antibody
   In itself, does NOT Dx SLE
8. Immunologic Disorder - abnormal immune tests
9. Neurologic Disorder - seizures OR psychosis
   In absense of another condiiton that could cause these)
10. Malar rash “butterfly rash” - erythema over the malar eminence (cheeks), tending to spare the nasolabial folds
11. Discoid rash - erythema raised patches, may cause scarring

** Not typical for these rashes to itch or hurt