Thursday, March 19, 2009

Diagnosis of Systemic Lupus Erythematosis

(Discoid rash on the left, and malar rash on the right)

The American College of Rheumatology have criteria for diagnosing Systemic Lupus Erythematosis. You need 4 of the following to have a diagnosis, or 3 to have a 'probable' diagnosis.
  1. Malar Rash: erythema over the malar eminences that spares the nasolabial folds.
  2. Discoid Rash: raised patches with scaling. This may scar.
  3. Photosensitivity: a rash on skin exposed to sunlight.
  4. Oral Ulcerations: usually painless. See image below.
  5. Arthritis: this is nonerosive and involves 2 or more peripheral joints.
  6. Serositis: like pericarditis or pleuritis. You may hear a 'rub' on physical exam.
  7. Renal Disease: >0.5 grams of protein per day, or casts (red or heme granular).
  8. Neurologic Disease: seizures or psychosis, with other causes ruled out.
  9. Hematologic Disease: hemolytic anemia, thromocyotopenia, leukopenia, or lymphopenia.
  10. Antinuclear Antibody: positive titre in the absence of drugs known to cause a high titre (eg. procainamide, hydralazine).
  11. Immunologic Disorders: Antiphospholipid antibodies, or Anti ds-DNA antibodies, or anti Smith antibodies, or a false positive VDRL.

(oral ulcerations)

No comments:

Post a Comment