Systemic Lupus

- Discussion:
    - affects periarticular soft tissues resulting in joint laxity with secondary dysfunction;
    - minimal synovitis - articular cartilage is preserved;
    - Raynaud's phenomenon is common;
    - diagnosis depends on positive F ANA test along with three other criteria:
           - swollen joints
           - nephritis
           - pericarditis
           - severe rash 
           - references:
                 - The 1982 revised criteria for the classification of systemic lupus erythematosus.
                 - Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.

- Clinical Presentation:
    - typically affects teenage girls;
    - constitutional symptoms are common;
    - malar (butterfly) rash;
    - affected systems:
           - renal
           - bone marrow
           - central nervous system
           - cardiopulmonary
           - joints:
                  - painful, debilitating, red, hot arthritis;
                  - rarely leads to deformity;
                  - arthritis responds to steroids;
    - lupus of the hand and wrist:
           - causes ligamentous laxity affecting the MCPs;
           - in contrast w/ SLE, in which phalanges are involved & knuckles are spared, erythema of dermatomyositis spares phalanges; 
           - reference:
                 - The hand in systemic lupus erythematosus
                 - Jaccoud’s Arthropathy

- Laboratory Aspects:
    - ANA is typically high ( > 1:640)
    - antidouble-stranded (native) DNA antibodies
    - lupus anticoagulant
    - complement;

- Treatment:
    - steroids:
    - methotrexate:
          - indicated for Lupus patients with major joint and/or skin involvement in whom their is no major organ involvement;
    - soft tissue reconstructions are not effective;
          - high recurrance rate
          - joint fusions are preferable to restore stability and function;
          - MP arthroplasties are effective even though they sacrifice normal appearing cartilage 


Patellar tendon rupture in systemic lupus erythematosus.

F.D.A. Panel Backs Drug for Lupus

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, August 11, 2015 6:06 pm