Systemic lupus erythematosus: Difference between revisions
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'''Systemic lupus erythematosis (SLE)''' is an [[autoimmunity|autoimmune]] [[connective tissue disorder]]. While there is no cure, there have been major advances in its treatment in recent years. | {{TOC|right}} | ||
'''Systemic lupus erythematosis (SLE)''' is an [[autoimmunity|autoimmune]] [[connective tissue disorder]]. While there is no cure, there have been major advances in its treatment in recent years. There are variants such as [[drug-induced lupus]] and [[discoid lupus]]. | |||
==Initial presentation== | ==Initial presentation== | ||
Symptoms can be diffuse, but one classical sign, not always present, is a "butterfly-shaped" rash centered on the nose. | Symptoms can be diffuse, but one classical sign, not always present, is a "butterfly-shaped" rash centered on the nose. | ||
==Diagnosis== | ==Diagnosis== | ||
[[Image:SLE-alternative criteria.jpg|thumb|right|250px|{{#ifexist:Template:SLE-alternative criteria.jpg/credit|{{SLE-alternative criteria.jpg/credit}}<br/>|}}Alternate criteria<ref name="pmid3060613">{{cite journal |author=Edworthy SM, Zatarain E, McShane DJ, Bloch DA |title=Analysis of the 1982 ARA lupus criteria data set by recursive partitioning methodology: new insights into the relative merit of individual criteria |journal=J. Rheumatol. |volume=15 |issue=10 |pages=1493-8 |year=1988 |pmid=3060613 |doi=}}</ref>]] | [[Image:SLE-alternative criteria.jpg|thumb|right|250px|{{#ifexist:Template:SLE-alternative criteria.jpg/credit|{{SLE-alternative criteria.jpg/credit}}<br/>|}}Alternate criteria<ref name="pmid3060613">{{cite journal |author=Edworthy SM, Zatarain E, McShane DJ, Bloch DA |title=Analysis of the 1982 ARA lupus criteria data set by recursive partitioning methodology: new insights into the relative merit of individual criteria |journal=J. Rheumatol. |volume=15 |issue=10 |pages=1493-8 |year=1988 |pmid=3060613 |doi=}}</ref>]] | ||
====Alternative criteria | ===Laboratory tests=== | ||
A number of immunologic tests are useful in diagnosis, and some in following disease progress. While the "LE prep" microscopic examination of the 1940s is obsolete, the first screening test is the [[antinuclear antibody titer]]. When these are elevated, more specific but less sensitive tests come into play, such as [[anti-double-stranded DNA antibodies]] (dsDNA) and [[anti-Smith antibodies]] (Sm). [[Antihistone antibodies]] are elevated in drug-induced lupus. <ref>{{citation | |||
| contribution = Chapter 5: Laboratory tests in rheumatic disorders | |||
| author = Peter H. Schur and Rober H. Scherling | |||
| title = Practical Rheumatology | |||
| edition = Third | |||
| publisher = Mosby | |||
| year = 2004 | |||
| isbn = 03230299396}}</ref> | |||
===Alternative criteria=== | |||
[[Recursive partitioning]] has been used to identify more parsimonious criteria. <ref name="pmid3060613">{{cite journal |author=Edworthy SM, Zatarain E, McShane DJ, Bloch DA |title=Analysis of the 1982 ARA lupus criteria data set by recursive partitioning methodology: new insights into the relative merit of individual criteria |journal=J. Rheumatol. |volume=15 |issue=10 |pages=1493-8 |year=1988 |pmid=3060613 |doi=}}</ref> This analysis presented two diagnostic classification trees: | [[Recursive partitioning]] has been used to identify more parsimonious criteria. <ref name="pmid3060613">{{cite journal |author=Edworthy SM, Zatarain E, McShane DJ, Bloch DA |title=Analysis of the 1982 ARA lupus criteria data set by recursive partitioning methodology: new insights into the relative merit of individual criteria |journal=J. Rheumatol. |volume=15 |issue=10 |pages=1493-8 |year=1988 |pmid=3060613 |doi=}}</ref> This analysis presented two diagnostic classification trees: | ||
Revision as of 23:09, 29 July 2010
Systemic lupus erythematosis (SLE) is an autoimmune connective tissue disorder. While there is no cure, there have been major advances in its treatment in recent years. There are variants such as drug-induced lupus and discoid lupus.
Initial presentation
Symptoms can be diffuse, but one classical sign, not always present, is a "butterfly-shaped" rash centered on the nose.
Diagnosis
Laboratory tests
A number of immunologic tests are useful in diagnosis, and some in following disease progress. While the "LE prep" microscopic examination of the 1940s is obsolete, the first screening test is the antinuclear antibody titer. When these are elevated, more specific but less sensitive tests come into play, such as anti-double-stranded DNA antibodies (dsDNA) and anti-Smith antibodies (Sm). Antihistone antibodies are elevated in drug-induced lupus. [2]
Alternative criteria
Recursive partitioning has been used to identify more parsimonious criteria. [1] This analysis presented two diagnostic classification trees:
1. Simplest classification tree: LSE is diagnosed if the patient has an immunologic disorder (anti-DNA antibody, anti-Smith antibody, false positive syphilis test, or LE cells) or malar rash.
- sensitivity = 92%
- specificity = 92%
2. Full classification tree: Uses 6 criteria.
- sensitivity = 97%
- specificity = 95%
Other alternative criteria have been suggested.[3]
Treatment
The beginnings of treatment, in the 1950s, used crude antiinflammatory and immunosuppressants such as ACTH. The core of today's treatment, however, are specific monoclonal antibodies.
References
- ↑ 1.0 1.1 Edworthy SM, Zatarain E, McShane DJ, Bloch DA (1988). "Analysis of the 1982 ARA lupus criteria data set by recursive partitioning methodology: new insights into the relative merit of individual criteria". J. Rheumatol. 15 (10): 1493-8. PMID 3060613. [e]
- ↑ Peter H. Schur and Rober H. Scherling (2004), Chapter 5: Laboratory tests in rheumatic disorders, Practical Rheumatology (Third ed.), Mosby, ISBN 03230299396
- ↑ Hughes GR (1998). "Is it lupus? The St. Thomas' Hospital "alternative" criteria". Clin. Exp. Rheumatol. 16 (3): 250-2. PMID 9631744. [e]