Scleroderma Systemic Lupus Erythematosus …
[Pages:47]Scleroderma Systemic Lupus Erythematosus
Dermatomyositis
A.C.O.I. Board Review 2019
Howard L. Feinberg, D.O., F.A.C.O.I., F.A.C.R.
Systemic Lupus Erythematosis
Incidence
? 20-150/100,000 ? 150-410 in women
Peak age 17-40
Female:Male
? 5:1 in peak ages ? 2:1 for all age
groups
Variants
Subacute Cutaneous Lupus
? non-fixed rash ? non-scarring ? associated with
SS-A antibody
Discoid
? Scarring rash with central atrophy
Lupus Pernio
? variant of sarcoidosis
? violacious plaques over the face, ears,
? 86% - hepatic granulomas
? 20%-hepatomegaly
Systemic (SLE)
DRUG INDUCED LUPUS
procainamide isoniazide hydralazine methyldopa chlorpromazine dilantin quinidine penicillamine possible association -
griseofulvin antibiotics, gold salts
ANA positive for up to 1 year
Anti-histone antibody positive in 95%
No change in complement
CNS and renal disease are rare
usually mild disease
ACR SLE Criteria
(must have at least 4 of 11)
1) Malar Rash 2) Discoid Rash 3) Photosensitive
Rash 4) Oral Ulcers 5) Arthritis 6) Serositis
7) Renal 8) Neurologic 9) Hematologic 10) Other Lab (antidouble stranded DNA, ENA, VDRL) 11) ANA
2012 SLICC SLE Diagnostic Criteria
Option One
4 criteria
? At least one clinical criteria
? At least one immunologic criteria
Option Two
Biopsy proven nephritis
Positive ANA or anti double stranded DNA
2012 SLICC
SLE Clinical Criteria
Acute cutaneous lupus
Neurologic (Seizure,
Chronic cutaneous lupus Oral ulcers
psychosis, myelitis, mononeuritis multiplex, acute confusion, cranial
Non scarring alopecia
neuropathy)
Synovitis (2 or more joints) Hemolytic anemia
Serositis
Leukopenia
Renal (>500mg protein or
RBC casts)
Thrombocytopenia
2012 SLICC SLE Laboratory Criteria
ANA Anti-DNA Anti-SM (Smith) Antiphospholipid low complement Direct coombs without hemolysis
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