SLE resident survival guide: Difference between revisions

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* [[Coombs' Test|Direct Coombs' test]] in the absence of [[hemolytic anemia]]
* [[Coombs' Test|Direct Coombs' test]] in the absence of [[hemolytic anemia]]
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=== Complete diagnostic approach: ===
=== Complete diagnostic approach: ===

Revision as of 17:17, 30 March 2018

SLE
Resident Survival Guide
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];

Overview

Causes

  • Exposure to ultraviolet (UV) light[3]
    • Can exacerbate or induce systemic manifestations of SLE 
  • Drug-induced lupus

FIRE

Diagnosis

Diagnostic criteria:

In 2012, Systemic Lupus International Collaboration Criteria (SLICC) developed a new criteria for SLE diagnosis. SLICC criteria for the classification of systemic lupus erythematosus was developed based on the old ACR criteria for the classification of systemic lupus erythematosus to address a more sensitive diagnostic criteria and also to cover weaknesses of the previous ACR criteria.[4][5]

Based on SLICC criteria, diagnosis of SLE is defined as:[6]

  • Meeting at least 4 of 17 criteria, including at least 1 of the 11 clinical criteria and one of the six immunologic criteria 

OR

A criterion is considered positive if one or more of the observations listed in the definition for the criterion are present in the patient. A criterion should only be counted once, regardless of the number of observations in the definition that the patient presents with.

Category Criterion Definition
Clinical Acute cutaneous lupus
Chronic cutaneous lupus
Nonscarring alopecia
Oral or nasal ulcers
Joint disease
Serositis
Renal
Neurologic
Hematologic Hemolytic anemia
  • Hemoglobin less than 12 g/dL in females and 13 g/dL in males
Leukopenia or lymphopenia
Thrombocytopenia
Immunologic ANA
  • ANA level above laboratory reference range
Anti-dsDNA
Anit-SM
Antiphospholipid
Low complement
  • Low C3
  • Low C4
  • Low CH50
Direct Coombs' test

Complete diagnostic approach:

Treatment

Do's

Don'ts

References

  1. Schur PH (1995). "Genetics of systemic lupus erythematosus". Lupus. 4 (6): 425–37. doi:10.1177/096120339500400603. PMID 8749564.
  2. Cutolo M, Sulli A, Seriolo B, Accardo S, Masi AT (1995). "Estrogens, the immune response and autoimmunity". Clin. Exp. Rheumatol. 13 (2): 217–26. PMID 7656468.
  3. Cooper GS, Dooley MA, Treadwell EL, St Clair EW, Gilkeson GS (2002). "Risk factors for development of systemic lupus erythematosus: allergies, infections, and family history". J Clin Epidemiol. 55 (10): 982–9. PMID 12464374.
  4. Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, Schaller JG, Talal N, Winchester RJ (1982). "The 1982 revised criteria for the classification of systemic lupus erythematosus". Arthritis Rheum. 25 (11): 1271–7. PMID 7138600.
  5. Hochberg MC (1997). "Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus". Arthritis Rheum. 40 (9): 1725. doi:10.1002/1529-0131(199709)40:9&lt;1725::AID-ART29&gt;3.0.CO;2-Y. PMID 9324032.
  6. Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, Bruce IN, Isenberg D, Wallace DJ, Nived O, Sturfelt G, Ramsey-Goldman R, Bae SC, Hanly JG, Sánchez-Guerrero J, Clarke A, Aranow C, Manzi S, Urowitz M, Gladman D, Kalunian K, Costner M, Werth VP, Zoma A, Bernatsky S, Ruiz-Irastorza G, Khamashta MA, Jacobsen S, Buyon JP, Maddison P, Dooley MA, van Vollenhoven RF, Ginzler E, Stoll T, Peschken C, Jorizzo JL, Callen JP, Lim SS, Fessler BJ, Inanc M, Kamen DL, Rahman A, Steinsson K, Franks AG, Sigler L, Hameed S, Fang H, Pham N, Brey R, Weisman MH, McGwin G, Magder LS (2012). "Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus". Arthritis Rheum. 64 (8): 2677–86. doi:10.1002/art.34473. PMC 3409311. PMID 22553077.