Systemic lupus erythematosus - Revision history

Aidan: /* Management */

2020-08-03T02:17:37Z

Management

← Older revision		Revision as of 02:17, 3 August 2020
Line 1:		Line 1:
	== Definition ==		==Definition==

	* Multisystem inflammatory disorder of unknown etiology		*Multisystem inflammatory disorder of unknown etiology

	== ACR Classification Criteria ==		==ACR Classification Criteria==

	4 or more of the following (4RASHES mnemonic)		4 or more of the following (4RASHES mnemonic)

	* Four dermatologic manifestations		*Four dermatologic manifestations
	** Malar rash: spares nasolabial folds		**Malar rash: spares nasolabial folds
	** Discoid rash: erythemaous plaques/patches		**Discoid rash: erythemaous plaques/patches
	** Photosensitivity: rash, not sunburn		**Photosensitivity: rash, not sunburn
	** Mucocutaneous ulcers: oropharynx or nasopharynx, often painless		**Mucocutaneous ulcers: oropharynx or nasopharynx, often painless
	* Renal disorder		*Renal disorder
	** Proteinuria >0.5g/d or 3+		**Proteinuria >0.5g/d or 3+
	** Any cellular or granular casts		**Any cellular or granular casts
	* Arthritis: non-erosive involving 2 or more joints		*Arthritis: non-erosive involving 2 or more joints
	* Serositis: pleuritis or pericarditis		*Serositis: pleuritis or pericarditis
	* Hematologic disorder		*Hematologic disorder
	** Hemolytic anemia		**Hemolytic anemia
	** Leukopenia		**Leukopenia
	** Lymphopenia: most important		**Lymphopenia: most important
	** Thrombocytopenia		**Thrombocytopenia
	* Neurological excitability		*Neurological excitability
	** Seizures		**Seizures
	** Psychosis		**Psychosis
	* Serology (non-ANA)		*Serology (non-ANA)
	** Anti-dsDNA antibodies		**Anti-dsDNA antibodies
	** Anti-Sm antibodies		**Anti-Sm antibodies
	** Anti-phospholipid antibodies		**Anti-phospholipid antibodies
	* Serology (ANA): most sensitive finding (~98%)		*Serology (ANA): most sensitive finding (~98%)

	== Clinical Manifestations ==		==Clinical Manifestations==

	* See above criteria		*See above criteria
	* Fevers and other constitutional symptoms		*Fevers and other constitutional symptoms
	* Any other non-specific rash, even if not in criteria		*Any other non-specific rash, even if not in criteria
	** Discoid rash forms scars		**Discoid rash forms scars
	* Alopecia, either discrete or global		*Alopecia, either discrete or global

	== Investigations ==		==Investigations==

	* Most important tests		*Most important tests
	** CBC for lymphopenia & other hematologic abnormalities		**CBC for lymphopenia & other hematologic abnormalities
	** Urinalysis for active sediment		**Urinalysis for active sediment
	* Serology		*Serology
	** ANA most sensitive, anti-Smith and anti-dsDNA are most specific		**ANA most sensitive, anti-Smith and anti-dsDNA are most specific
	** APLA		**APLA
	** Can be either seroconcordant or -discordant for dsDNA, C3/C4, ESR/CRP during flares		**Can be either seroconcordant or -discordant for dsDNA, C3/C4, ESR/CRP during flares

	== Management ==		==Management==

	=== Acute ===		===Acute===

	* Prednisone 0.5-~~1mg~~/kg depending on severity		*[[Prednisone]] 0.5-1 mg/kg depending on severity
	* Cyclophosphamide if severe or renal involvement		*[[Cyclophosphamide]] if severe or renal involvement
	* vs. MMF		**vs. [[MMF]]

	=== Chronic ===		===Chronic===

	* Hydroxychloroquine		*[[Hydroxychloroquine]]
	** Load with 400-~~600mg~~ TDD split BID for 1-3 months		**Load with 400-600 mg TDD split BID for 1-3 months
	** Step down to 6.~~75mg~~/kg maintenance		**Step down to 6.75 mg/kg maintenance
	** Needs ~~ophtho~~ follow-up for rare macular side effect		**Needs Ophthalmology follow-up for rare macular side effect
	** Best for skin		**Best for skin
	* Azathioprine as steroid-sparing agent		*[[Azathioprine]] as steroid-sparing agent

	[[Category:Rheumatology]]		[[Category:Rheumatology]]

Aidan: Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

2020-08-02T12:03:06Z

Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

← Older revision		Revision as of 12:03, 2 August 2020
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	* Serology (ANA): most sensitive finding (~98%)		* Serology (ANA): most sensitive finding (~98%)

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* See above criteria		* See above criteria

Maintenance script: Imported from text file

2020-07-04T01:17:58Z

Imported from text file

New page

== Definition ==

* Multisystem inflammatory disorder of unknown etiology

== ACR Classification Criteria ==

4 or more of the following (4RASHES mnemonic)

* Four dermatologic manifestations
** Malar rash: spares nasolabial folds
** Discoid rash: erythemaous plaques/patches
** Photosensitivity: rash, not sunburn
** Mucocutaneous ulcers: oropharynx or nasopharynx, often painless
* Renal disorder
** Proteinuria >0.5g/d or 3+
** Any cellular or granular casts
* Arthritis: non-erosive involving 2 or more joints
* Serositis: pleuritis or pericarditis
* Hematologic disorder
** Hemolytic anemia
** Leukopenia
** Lymphopenia: most important
** Thrombocytopenia
* Neurological excitability
** Seizures
** Psychosis
* Serology (non-ANA)
** Anti-dsDNA antibodies
** Anti-Sm antibodies
** Anti-phospholipid antibodies
* Serology (ANA): most sensitive finding (~98%)

== Clinical Presentation ==

* See above criteria
* Fevers and other constitutional symptoms
* Any other non-specific rash, even if not in criteria
** Discoid rash forms scars
* Alopecia, either discrete or global

== Investigations ==

* Most important tests
** CBC for lymphopenia & other hematologic abnormalities
** Urinalysis for active sediment
* Serology
** ANA most sensitive, anti-Smith and anti-dsDNA are most specific
** APLA
** Can be either seroconcordant or -discordant for dsDNA, C3/C4, ESR/CRP during flares

== Management ==

=== Acute ===

* Prednisone 0.5-1mg/kg depending on severity
* Cyclophosphamide if severe or renal involvement
* vs. MMF

=== Chronic ===

* Hydroxychloroquine
** Load with 400-600mg TDD split BID for 1-3 months
** Step down to 6.75mg/kg maintenance
** Needs ophtho follow-up for rare macular side effect
** Best for skin
* Azathioprine as steroid-sparing agent

[[Category:Rheumatology]]