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Systemic Lupus

Discussion


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:

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

References