Systemic lupus erythematosus - Revision history

Danbot: Strip excess bold

2026-03-22T09:37:26Z

Strip excess bold

← Older revision		Revision as of 09:37, 22 March 2026
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	[[File:PMC3410306 AD2012-834291.004.png\|thumb\|Palatal ulcer in SLE]]		[[File:PMC3410306 AD2012-834291.004.png\|thumb\|Palatal ulcer in SLE]]
	[[File:PMC3410306 AD2012-834291.005.png\|thumb\|Subacute cutaneous SLE]]		[[File:PMC3410306 AD2012-834291.005.png\|thumb\|Subacute cutaneous SLE]]
	~~'''~~SLICC Classification Criteria 2012~~'''~~ <ref>Lisnevskaia L, et al. Systemic Lupus Erythematosus. Lancet. 2014 May 29. Epub ahead of print.</ref>		SLICC Classification Criteria 2012 <ref>Lisnevskaia L, et al. Systemic Lupus Erythematosus. Lancet. 2014 May 29. Epub ahead of print.</ref>
	Requirements: >4 of the following criteria (at least 1 clinical and 1 laboratory) ~~'''~~OR~~'''~~ biopsy proven lupus nephritis with		Requirements: >4 of the following criteria (at least 1 clinical and 1 laboratory) OR biopsy proven lupus nephritis with
	positive ANA or Anti-dsDNA		positive ANA or Anti-dsDNA
	*Clinical criteria		*Clinical criteria
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	**Direct Coombs' test in the absence of haemolytic anaemia		**Direct Coombs' test in the absence of haemolytic anaemia

	~~'''~~Organ system affected:~~'''~~		Organ system affected:
	*Cardiopulmonary		*Cardiopulmonary
	**[[Pneumonia]]		**[[Pneumonia]]
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	==Evaluation==		==Evaluation==
	~~'''~~Undiagnosed~~'''~~		Undiagnosed
	*CBC		*CBC
	*Chem 10		*Chem 10
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	*(Consider anti-DNA, anti-Smith, anti-Nuclear, anti-phospholipid, C3,C4, direct Coombs')		*(Consider anti-DNA, anti-Smith, anti-Nuclear, anti-phospholipid, C3,C4, direct Coombs')

	~~'''~~Flare~~'''~~		Flare
	*Bedside echo if ill or hypotensive		*Bedside echo if ill or hypotensive
	*CBC		*CBC
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	*As directed by organ system involved		*As directed by organ system involved

	~~'''~~Drug Induced Lupus~~'''~~		Drug Induced Lupus
	*Anti-histone-Ab positive 95% of the time		*Anti-histone-Ab positive 95% of the time
	*Make sure to review medications		*Make sure to review medications
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	*Must differentiate disease activity (flare) from infection		*Must differentiate disease activity (flare) from infection

	~~'''~~Risk Factors for Infection~~'''~~ <ref>Cuchacovich, R., & Gedalia, A. (2009). Pathophysiology and clinical spectrum of infections in systemic lupus erythematosus. Rheumatic diseases clinics of North America, 35(1), 75–93. doi:10.1016/j.rdc.2009.03.003</ref>		Risk Factors for Infection <ref>Cuchacovich, R., & Gedalia, A. (2009). Pathophysiology and clinical spectrum of infections in systemic lupus erythematosus. Rheumatic diseases clinics of North America, 35(1), 75–93. doi:10.1016/j.rdc.2009.03.003</ref>
	*[[Neutropenia]]/Lymphopenia		*[[Neutropenia]]/Lymphopenia
	*Hypocomplementemia		*Hypocomplementemia
	*Immunosuppressive therapy (especially [[azathioprine]] <ref>Zhou, W. J., & Yang, C.-D. (2009). The causes and clinical significance of fever in systemic lupus erythematosus: a retrospective study of 487 hospitalised patients. Lupus, 18(9), 807–812. doi:10.1177/0961203309103870</ref>)		*Immunosuppressive therapy (especially [[azathioprine]] <ref>Zhou, W. J., & Yang, C.-D. (2009). The causes and clinical significance of fever in systemic lupus erythematosus: a retrospective study of 487 hospitalised patients. Lupus, 18(9), 807–812. doi:10.1177/0961203309103870</ref>)

	~~'''~~Studies~~'''~~		Studies
	*CRP: sensitivity 100%, specificity 90% >1.35mg/dL <ref>Kim, H.-A., Jeon, J.-Y., An, J.-M., Koh, B.-R., & Suh, C.-H. (2012). C-reactive protein is a more sensitive and specific marker for diagnosing bacterial infections in systemic lupus erythematosus compared to S100A8/A9 and procalcitonin. The Journal of rheumatology, 39(4), 728–734. doi:10.3899/jrheum.111044</ref>		*CRP: sensitivity 100%, specificity 90% >1.35mg/dL <ref>Kim, H.-A., Jeon, J.-Y., An, J.-M., Koh, B.-R., & Suh, C.-H. (2012). C-reactive protein is a more sensitive and specific marker for diagnosing bacterial infections in systemic lupus erythematosus compared to S100A8/A9 and procalcitonin. The Journal of rheumatology, 39(4), 728–734. doi:10.3899/jrheum.111044</ref>
	*PCT: sensitivity 75%, specificity 75% <ref>Scirè, C. A., Cavagna, L., Perotti, C., Bruschi, E., Caporali, R., & Montecucco, C. (2006). Diagnostic value of procalcitonin measurement in febrile patients with systemic autoimmune diseases. Clinical and experimental rheumatology, 24(2), 123–128.</ref>		*PCT: sensitivity 75%, specificity 75% <ref>Scirè, C. A., Cavagna, L., Perotti, C., Bruschi, E., Caporali, R., & Montecucco, C. (2006). Diagnostic value of procalcitonin measurement in febrile patients with systemic autoimmune diseases. Clinical and experimental rheumatology, 24(2), 123–128.</ref>

Danbot: Add MedicationDose entry (methylprednisolone) with SMW annotations

2026-03-20T19:02:46Z

Add MedicationDose entry (methylprednisolone) with SMW annotations

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 *[[Chest pain]] requires urgent [[ACS]] evaluation
 *Infections usually require admission for [[antibiotics]] and systemic [[corticosteroids]]
 ==See Also==

Elcatracho: /* Disposition */

2022-01-10T20:45:35Z

Disposition

← Older revision		Revision as of 20:45, 10 January 2022
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	*Musculoskeletal symptoms can usually be managed as out patients		*Musculoskeletal symptoms can usually be managed as out patients
	*[[Chest pain]] requires urgent [[ACS]] evaluation		*[[Chest pain]] requires urgent [[ACS]] evaluation
	*Infections usually require admission for antibiotics and systemic corticosteroids		*Infections usually require admission for [[antibiotics]] and systemic [[corticosteroids]]

	==See Also==		==See Also==

Elcatracho: /* Management */

2022-01-10T20:43:22Z

Management

← Older revision		Revision as of 20:43, 10 January 2022
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	**[[Methylprednisolone]] 1-2mg/kg in most cases		**[[Methylprednisolone]] 1-2mg/kg in most cases
	*Infectious		*Infectious
	**Stress dose steroids with [[hydrocortisone]] 100mg IV Q8hr if on or recently on steroids		**Stress dose [[steroids]] with [[hydrocortisone]] 100mg IV Q8hr if on or recently on steroids
	*Dermatologic		*Dermatologic
	**[[Hydrocortisone]] 1% cream		**[[Hydrocortisone]] 1% cream

Elcatracho: /* Disposition */

2022-01-10T20:42:15Z

Disposition

← Older revision		Revision as of 20:42, 10 January 2022
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	*Mild flairs can have expedited out patient management		*Mild flairs can have expedited out patient management
	*Musculoskeletal symptoms can usually be managed as out patients		*Musculoskeletal symptoms can usually be managed as out patients
	*[[Chest pain]] requires urgent ACS evaluation		*[[Chest pain]] requires urgent [[ACS]] evaluation
	*Infections usually require admission for antibiotics and systemic corticosteroids		*Infections usually require admission for antibiotics and systemic corticosteroids

Rossdonaldson1: /* Clinical Features */

2019-11-27T04:16:51Z

Clinical Features

← Older revision		Revision as of 04:16, 27 November 2019
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	[[File:Lupusfoto.jpg\|thumb\|Typical "butterfly" malar rash.]]		[[File:Lupusfoto.jpg\|thumb\|Typical "butterfly" malar rash.]]
	[[File:PMC3410306 AD2012-834291.004.png\|thumb\|Palatal ulcer in SLE]]		[[File:PMC3410306 AD2012-834291.004.png\|thumb\|Palatal ulcer in SLE]]
			[[File:PMC3410306 AD2012-834291.005.png\|thumb\|Subacute cutaneous SLE]]
	'''SLICC Classification Criteria 2012''' <ref>Lisnevskaia L, et al. Systemic Lupus Erythematosus. Lancet. 2014 May 29. Epub ahead of print.</ref>		'''SLICC Classification Criteria 2012''' <ref>Lisnevskaia L, et al. Systemic Lupus Erythematosus. Lancet. 2014 May 29. Epub ahead of print.</ref>
	Requirements: >4 of the following criteria (at least 1 clinical and 1 laboratory) '''OR''' biopsy proven lupus nephritis with		Requirements: >4 of the following criteria (at least 1 clinical and 1 laboratory) '''OR''' biopsy proven lupus nephritis with

Rossdonaldson1: /* Clinical Features */

2019-11-27T04:15:25Z

Clinical Features

← Older revision		Revision as of 04:15, 27 November 2019
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	**Malar [[rash]] across bridge of nose		**Malar [[rash]] across bridge of nose
	**Discoid rash, erythematous with scale		**Discoid rash, erythematous with scale
	**Treat with topical 1% [[hydrocortisone]]

	*Renal		*Renal

Rossdonaldson1: /* Clinical Features */

2019-11-27T04:15:02Z

Clinical Features

← Older revision		Revision as of 04:15, 27 November 2019
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	==Clinical Features==		==Clinical Features==
	[[File:Lupusfoto.jpg\|thumb\|Typical "butterfly" rash.]]		[[File:Lupusfoto.jpg\|thumb\|Typical "butterfly" malar rash.]]
			[[File:PMC3410306 AD2012-834291.004.png\|thumb\|Palatal ulcer in SLE]]
	'''SLICC Classification Criteria 2012''' <ref>Lisnevskaia L, et al. Systemic Lupus Erythematosus. Lancet. 2014 May 29. Epub ahead of print.</ref>		'''SLICC Classification Criteria 2012''' <ref>Lisnevskaia L, et al. Systemic Lupus Erythematosus. Lancet. 2014 May 29. Epub ahead of print.</ref>
	Requirements: >4 of the following criteria (at least 1 clinical and 1 laboratory) '''OR''' biopsy proven lupus nephritis with		Requirements: >4 of the following criteria (at least 1 clinical and 1 laboratory) '''OR''' biopsy proven lupus nephritis with

Rossdonaldson1: /* Clinical Features */

2019-11-27T04:09:03Z

Clinical Features

← Older revision		Revision as of 04:09, 27 November 2019
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	==Clinical Features==		==Clinical Features==
			[[File:Lupusfoto.jpg\|thumb\|Typical "butterfly" rash.]]
	'''SLICC Classification Criteria 2012''' <ref>Lisnevskaia L, et al. Systemic Lupus Erythematosus. Lancet. 2014 May 29. Epub ahead of print.</ref>		'''SLICC Classification Criteria 2012''' <ref>Lisnevskaia L, et al. Systemic Lupus Erythematosus. Lancet. 2014 May 29. Epub ahead of print.</ref>
	Requirements: >4 of the following criteria (at least 1 clinical and 1 laboratory) '''OR''' biopsy proven lupus nephritis with		Requirements: >4 of the following criteria (at least 1 clinical and 1 laboratory) '''OR''' biopsy proven lupus nephritis with

ClaireLewis at 15:58, 18 October 2019

2019-10-18T15:58:58Z

← Older revision		Revision as of 15:58, 18 October 2019
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	positive ANA or Anti-dsDNA		positive ANA or Anti-dsDNA
	*Clinical criteria		*Clinical criteria
	**Malar rash, bullous lupus, photosensitivity		**Malar [[rash]], bullous lupus, photosensitivity
	**Discoid rash, hypertrophic lupus		**Discoid rash, hypertrophic lupus
	**Oral ulcers or nasal ulcers		**Oral ulcers or nasal ulcers
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	**Synovitis		**Synovitis
	**Serositis		**Serositis
	**Nephritis		**[[glomerulonephritis\|Nephritis]]
	**Cerebritis, myelitis, neuropathy		**Cerebritis, myelitis, neuropathy
	**Hemolytic anemia		**[[Hemolytic anemia]]
	**Leukopenia or lymphopenia		**[[Leukopenia]] or lymphopenia
	**Thrombocytopenia		**[[Thrombocytopenia]]

	*Immunological criteria		*Immunological criteria
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	'''Organ system affected:'''		'''Organ system affected:'''
	*Cardiopulmonary		*Cardiopulmonary
	**Pneumonia		**[[Pneumonia]]
	***Cover for ''[[Listeria]]'' and ''[[Pseudomonas]]''		***Cover for ''[[Listeria]]'' and ''[[Pseudomonas]]''
	**CAD		**CAD
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	***Infectious and Libman-Sachs		***Infectious and Libman-Sachs

	*Neuropsychiatric/Altered mental status		*Neuropsychiatric/[[Altered mental status]]
	**Non-convulsive status epilepticus		**Non-convulsive [[status epilepticus]]
	**CNS vasculitis		**CNS [[vasculitis]]
	**[[Stroke]]		**[[Stroke]]
	**[[Encephalitis]]		**[[Encephalitis]]
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	*Musculoskeletal		*Musculoskeletal
	**Arthritis		**[[Arthritis]]
	***Usually symmetric		***Usually symmetric
	***Consider septic arthritis if there is a single inflamed joint		***Consider [[septic arthritis]] if there is a single inflamed joint
	****Cover for [[Salmonella]] in addition to standard coverage		****Cover for [[Salmonella]] in addition to standard coverage

	*GI		*GI
	**Lupus enteritis (mesenteric vasculitis)		**Lupus enteritis (mesenteric [[vasculitis]])
	***Most common cause of acute abdominal pain		***Most common cause of acute [[abdominal pain]]
	**[[Pancreatitis]]		**[[Pancreatitis]]
	**PUD		**[[PUD]]

	*Dermatologic		*Dermatologic
	**Malar rash across bridge of nose		**Malar [[rash]] across bridge of nose
	**Discoid rash, erythematous with scale		**Discoid rash, erythematous with scale
	**Treat with topical 1% hydrocortisone		**Treat with topical 1% [[hydrocortisone]]

	*Renal		*Renal
	**Usually a nephritis		**Usually a [[glomerulonephritis\|nephritis]]
	**Can cause a glomerulonephrosis		**Can cause a glomerulonephrosis

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	*ESR		*ESR
	*[[Urinalysis]]		*[[Urinalysis]]
	*Bedside ~~echo~~ if ill or hypotensive		*Bedside [[echocardiography]] if ill or hypotensive
	*(Consider anti-DNA, anti-Smith, anti-Nuclear, anti-phospholipid, C3,C4, direct Coombs')		*(Consider anti-DNA, anti-Smith, anti-Nuclear, anti-phospholipid, C3,C4, direct Coombs')

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	*Make sure to review medications		*Make sure to review medications
	**High risk:		**High risk:
	***Procainamide (antiarrhythmic)		***[[Procainamide]] (antiarrhythmic)
	***Hydralazine (antihypertensive)		***[[Hydralazine]] (antihypertensive)
	**Moderate to low risk:		**Moderate to low risk:
	***Infliximab anti (TNF-α)		***Infliximab anti (TNF-α)
	***Etanercept anti (TNF-α)		***Etanercept anti (TNF-α)
	***Isoniazid (antibiotic)		***[[Isoniazid]] (antibiotic)
	***Minocycline (antibiotic)		***[[Minocycline]] (antibiotic)
	***Pyrazinamide (antibiotic)		***[[Pyrazinamide]] (antibiotic)
	***Quinidine (antiarrhythmic)		***[[Quinidine]] (antiarrhythmic)
	***D-Penicillamine (anti-inflammatory)		***D-[[Penicillamine]] (anti-inflammatory)
	***Carbamazepine (anticonvulsant)		***[[Carbamazepine]] (anticonvulsant)
	***Oxcarbazepine (anticonvulsant)		***[[Oxcarbazepine]] (anticonvulsant)
	***Phenytoin (anticonvulsant)		***[[Phenytoin]] (anticonvulsant)
	***Propafenone (antiarrhythmic)		***Propafenone (antiarrhythmic)
	***Chlorpromazine (antipsychotic)		***[[Chlorpromazine]] (antipsychotic)

	===Fever in SLE===		===[[Fever]] in SLE===
	*Must differentiate disease activity (flare) from infection		*Must differentiate disease activity (flare) from infection

	'''Risk Factors for Infection''' <ref>Cuchacovich, R., & Gedalia, A. (2009). Pathophysiology and clinical spectrum of infections in systemic lupus erythematosus. Rheumatic diseases clinics of North America, 35(1), 75–93. doi:10.1016/j.rdc.2009.03.003</ref>		'''Risk Factors for Infection''' <ref>Cuchacovich, R., & Gedalia, A. (2009). Pathophysiology and clinical spectrum of infections in systemic lupus erythematosus. Rheumatic diseases clinics of North America, 35(1), 75–93. doi:10.1016/j.rdc.2009.03.003</ref>
	*Neutropenia/Lymphopenia		*[[Neutropenia]]/Lymphopenia
	*Hypocomplementemia		*Hypocomplementemia
	*Immunosuppressive therapy (especially ~~Azathioprine~~ <ref>Zhou, W. J., & Yang, C.-D. (2009). The causes and clinical significance of fever in systemic lupus erythematosus: a retrospective study of 487 hospitalised patients. Lupus, 18(9), 807–812. doi:10.1177/0961203309103870</ref>)		*Immunosuppressive therapy (especially [[azathioprine]] <ref>Zhou, W. J., & Yang, C.-D. (2009). The causes and clinical significance of fever in systemic lupus erythematosus: a retrospective study of 487 hospitalised patients. Lupus, 18(9), 807–812. doi:10.1177/0961203309103870</ref>)

	'''Studies'''		'''Studies'''
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	==Management==		==Management==
	*Inflammatory complications		*Inflammatory complications
	**Methylprednisolone 1-2mg/kg in most cases		**[[Methylprednisolone]] 1-2mg/kg in most cases
	*Infectious		*Infectious
	**Stress dose steroids with hydrocortisone 100mg IV Q8hr if on or recently on steroids		**Stress dose steroids with [[hydrocortisone]] 100mg IV Q8hr if on or recently on steroids
	*Dermatologic		*Dermatologic
	**Hydrocortisone 1% cream		**[[Hydrocortisone]] 1% cream
	*If drug induced lupus, stop medication and consider alternative		*If drug induced lupus, stop medication and consider alternative