Systemic lupus erythematosus classification scheme: Difference between revisions

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=== SLE classification based on [[glomerulonephritis]] ===
=== SLE classification based on [[glomerulonephritis]] ===
SLE may be classified according to [[glomerulonephritis]] into 6 subtypes:
SLE may be classified according to [[glomerulonephritis]] into 6 subtypes:<ref name="pmid12858447">{{cite journal |vauthors=Mannik M, Merrill CE, Stamps LD, Wener MH |title=Multiple autoantibodies form the glomerular immune deposits in patients with systemic lupus erythematosus |journal=J. Rheumatol. |volume=30 |issue=7 |pages=1495–504 |year=2003 |pmid=12858447 |doi= |url=}}</ref><ref name="pmid14530779">{{cite journal |vauthors=Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR |title=Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients |journal=Medicine (Baltimore) |volume=82 |issue=5 |pages=299–308 |year=2003 |pmid=14530779 |doi=10.1097/01.md.0000091181.93122.55 |url=}}</ref><ref name="pmid14717922">{{cite journal |vauthors=Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M |title=The classification of glomerulonephritis in systemic lupus erythematosus revisited |journal=Kidney Int. |volume=65 |issue=2 |pages=521–30 |year=2004 |pmid=14717922 |doi=10.1111/j.1523-1755.2004.00443.x |url=}}</ref>
* Minimal mesangial lupus nephritis (class I)
* Minimal mesangial lupus nephritis (class I)
* Mesangial proliferative lupus nephritis (class II)
* Mesangial proliferative lupus nephritis (class II)
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* [[Hematuria]] and [[proteinuria]]
* [[Hematuria]] and [[proteinuria]]
* [[Nephrotic syndrome]], [[hypertension]], and reduced [[glomerular filtration rate]]
* [[Nephrotic syndrome]], [[hypertension]], and reduced [[glomerular filtration rate]]
* [[Hypocomplementemia]] (especially C3) and elevated anti-DNA levels, especially during active disease 7231154
* [[Hypocomplementemia]] (especially C3) and elevated anti-DNA levels, especially during active disease <ref name="pmid7231154">{{cite journal |vauthors=Lloyd W, Schur PH |title=Immune complexes, complement, and anti-DNA in exacerbations of systemic lupus erythematosus (SLE) |journal=Medicine (Baltimore) |volume=60 |issue=3 |pages=208–17 |year=1981 |pmid=7231154 |doi= |url=}}</ref>
|-
|-
|Lupus membranous [[nephropathy]] (class V) 
|Lupus membranous [[nephropathy]] (class V) 

Revision as of 13:43, 30 June 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Kiran Singh, M.D. [3]

Overview

Lupus may be classified into several subtypes according to clinical features which include: systemic lupus erythematosus, cutaneous lupus erythematosus, drug-induced lupus, and neonatal lupus. Systemic lupus erythematosus (SLE) itself may be classified into several subtypes based on glomerulonephritis and dermatologic manifestation. SLE may be classified according to dermatologic manifestations into 4 subtypes: acute cutaneous lupus erythematosus (ACLE), subacute cutaneous lupus erythematosus (SCLE), chronic cutaneous lupus erythematosus (CCLE), and intermittent cutaneous lupus erythematosus (ICLE). SLE may be classified according to glomerulonephritis into 6 subtypes: minimal mesangial lupus nephritis (class I), mesangial proliferative lupus nephritis (class II), focal lupus nephritis (class III), diffuse lupus nephritis (class IV), lupus membranous nephropathy (class V), and advanced sclerosing lupus nephritis (class VI).

Classification

Lupus may be classified into several subtypes according to clinical features which include:

  • Systemic lupus erythematosus (SLE)
  • Cutaneous lupus erythematosus (CLE)
  • Drug-induced lupus
  • Neonatal lupus

Based on this classification, SLE is a subtype of lupus that can be classified into different subclasses as well. CLE can be presented with or without systemic symptoms of the disease.

Systemic lupus erythematosus (SLE) may be classified into several subtypes based on glomerulonephritis and dermatologic manifestation.

SLE classification based on dermatologic manifestations

SLE may be classified according to dermatologic manifestations into 4 subtypes:

  • Acute cutaneous lupus erythematosus (ACLE)
  • Subacute cutaneous lupus erythematosus (SCLE)
  • Chronic cutaneous lupus erythematosus (CCLE)
  • Intermittent cutaneous lupus erythematosus (ICLE)
Subtypes Manifestation/subclass
Acute cutaneous lupus erythematosus (ACLE)
Subacute cutaneous lupus erythematosus (SCLE)
  • Annular SCLE
  • Papulosquamous SCLE
  • Drug-induced SCLE
  • Neonatal lupus (dermatitis manifestations)
  • Less common subtypes:
    • Erythrodermic
    • Poikilodermatous
    • Erythema multiforme-like (Rowell syndrome)
    • Vesiculobullous annular SCLE
Chronic cutaneous lupus erythematosus (CCLE)
  • Discoid lupus erythematosus (DLE)
    • Localized DLE
    • Generalized DLE
    • Hypertrophic DLE
  • Lupus erythematosus tumidus (LE tumidus)
  • Lupus profundus (also known as lupus panniculitis)
  • Chilblain lupus erythematosus (chilblain LE)
  • Lichenoid cutaneous lupus erythematosus-lichen planus overlap syndrome (LE-LP overlap syndrome)
Intermittent cutaneous lupus erythematosus (ICLE)
  • A consistent histopathologic feature of ACLE, SCLE, and discoid lupus erythematosus

SLE classification based on glomerulonephritis

SLE may be classified according to glomerulonephritis into 6 subtypes:[1][2][3]

  • Minimal mesangial lupus nephritis (class I)
  • Mesangial proliferative lupus nephritis (class II)
  • Focal lupus nephritis (class III)
  • Diffuse lupus nephritis (class IV)
  • Lupus membranous nephropathy (class V)
  • Advanced sclerosing lupus nephritis (class VI)
Subtype Manifestation
Minimal mesangial lupus nephritis (class I)
Mesangial proliferative lupus nephritis (class II)
Focal lupus nephritis (class III)
Diffuse lupus nephritis (class IV)
  • Most common and most severe form
Lupus membranous nephropathy (class V) 
Advanced sclerosing lupus nephritis (class VI)
    • Chilblain lupus erythematosus (Hutchinson)
    • Lupus erythematosus-lichen planus overlap syndrome
    • Lupus erythematosus panniculitis (Lupus erythematosus profundus)
    • Subacute cutaneous lupus erythematosus, which causes nonscarring skin lesions on patches of skin exposed to sunlight.[5]
    • Tumid lupus erythematosus
    • Verrucous lupus erythematosus (Hypertrophic lupus erythematosus)
  • Neonatal lupus erythematosus, a rare disease affecting babies born to women with SLE, Sjögren's syndrome, or sometimes no autoimmune disorder. It is theorized that maternal antibodies attack the fetus, causing skin rash; liver problems; low blood counts, which gradually fade; and heart block, leading to bradycardia.[5]
  • Childhood systemic lupus erythematosus, the pediatric variant of systemic lupus erythematosus.
  • Drug-induced lupus erythematosus, a drug-induced form of SLE; this type of lupus can occur equally in either gender.
  • Lupus nephritis, an inflammation of the kidneys caused by SLE
  • Complement deficiency syndromes
Trunk
Extremity
Lupus Erythematosus Chronicus Verrrucous
Extremity


Trunk
Lupus Erythematosus Profundus
Extremity
Subacute Cutaneous Lupus Erythematosus
Face
Head
Trunk
Systemic Lupus Erythematosus
Face

References

  1. ↑ Mannik M, Merrill CE, Stamps LD, Wener MH (2003). "Multiple autoantibodies form the glomerular immune deposits in patients with systemic lupus erythematosus". J. Rheumatol. 30 (7): 1495–504. PMID 12858447.
  2. ↑ Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR (2003). "Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients". Medicine (Baltimore). 82 (5): 299–308. doi:10.1097/01.md.0000091181.93122.55. PMID 14530779.
  3. ↑ Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M (2004). "The classification of glomerulonephritis in systemic lupus erythematosus revisited". Kidney Int. 65 (2): 521–30. doi:10.1111/j.1523-1755.2004.00443.x. PMID 14717922.
  4. ↑ Lloyd W, Schur PH (1981). "Immune complexes, complement, and anti-DNA in exacerbations of systemic lupus erythematosus (SLE)". Medicine (Baltimore). 60 (3): 208–17. PMID 7231154.
  5. ↑ 5.0 5.1 "Handout on Health: Systemic Lupus Erythematosus". The National Institute of Arthritis and Musculoskeletal and Skin Diseases. National Institutes of Health. 2003. Retrieved 2007-11-23. Unknown parameter |month= ignored (help)
  6. ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 6.31 6.32 "Dermatology Atlas".

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