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

References

• Patellar tendon rupture in systemic lupus erythematosus.
• F.D.A. Panel Backs Drug for Lupus