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→Systemic Lupus Erythematosus
Autoimmune inflammatory condition caused by antibody-antigen deposition in various tissues.
Autoimmune inflammatory condition caused by antibody-antigen deposition in various tissues.
*H&P: Young women, blacks, hispanics, asians
*H&P: Young women, blacks, hispanics, asians
*Dx: DOPAMINe RASH 4 of 11 criteria, rule out 2° causes (drug-induced lupus SHIPP: sulfonamides, hydralazine, isoniazid, phenytoin, procainamide). Best screening test is ANA (98% sensitivity), most specific are anti ds-DNA, anti-Sm. Complement C3 and C4 levels can also be low, especially during acute flares.
*Dx: DOPAMINe RASH 4 of 11 criteria, rule out 2° causes (drug-induced lupus SHIPP: sulfonamides, hydralazine, isoniazid, phenytoin, procainamide). Best screening test is ANA (98% sensitivity), '''anti-dsDNA''' is relatively sensitive and specific, and '''anti-Sm''' is the most specific, but not sensitive. Complement C3 and C4 levels can also be low, especially during acute flares.
*Tx: NSAIDs for arthritis and mild serositis; hydroxychloroquine for skin and renal disease; for moderate to severe disease, use corticosteroids or anti B cell biologics; for acute flares, use steroid tapers. Test for anti-SSA in patients thinking about getting pregnant, as this antibody can cross the placenta and cause neonatal lupus and complete heart block. If patient has anti-phospholipid antibody syndrome, they need lifelong warfarin.
*Tx: NSAIDs for arthritis and mild serositis; hydroxychloroquine for skin and renal disease; for moderate to severe disease, use corticosteroids or anti B cell biologics; for acute flares, use steroid tapers. Test for anti-SSA in patients thinking about getting pregnant, as this antibody can cross the placenta and cause neonatal lupus and complete heart block. If patient has anti-phospholipid antibody syndrome, they need lifelong warfarin.