Systemic Lupus Erythematosus Diagnosis


Step 1: Organ Systems Affected
<-- Constitutional: Fatigue, fever (in the absence of infection), weight loss
<-- Skin: Butterfly rash, photosensitivity rash, mucous membrane lesion, alopecia, Raynaud’s phenomenon, purpura, urticaria, vasculitis
<-- Musculoskeletal: Arthritis, arthralgia, myositis
<-- Renal: Hematuria, proteinuria, cellular casts, nephrotic syndrome
<-- Hematologic: Anemia, thrombocytopenia, leukopenia
<-- Reticuloendothelial: Lymphadenopathy, splenomegaly, hepatomegaly
<-- Neuropsychiatric: Psychosis, seizures, organic brain syndrome, transverse myelitis, cranial neuropathies, peripheral neuropathies
<-- Gastrointestinal: Nausea, vomiting, abdominal pain
<-- Cardiac: Pericarditis, endocarditis, myocarditis
<-- Pulmonary: Pleurisy, pulmonary hypertension, pulmonary parenchymal disease

Step 2: If 2 or more systems in Step 1 are affected then get ANA titer.
<-- ANA titer

Step 3: If the titer is greater than 1:40 then get the labs (complete blood count; urinalysis; serum creatine level; and antiphospholipid, anti- dsDNA, and anti-Sm antibodies.) The diagnosis of systemic lupus erythematosus requires the presence of four or more of the following 11 criteria, serially or simultaneously, during any period of observation.
<-- Malar rash: fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds
<-- Discoid rash: erythematous, raised patches with adherent keratotic scaling and follicular plugging; possibly atrophic scarring in older lesions
<-- Photosensitivity: skin rash as a result of unusual reaction to sunlight, as determined by patient history or physician observation
<-- Oral ulcers: oral or nasopharyngeal ulceration, usually painless, observed by physician
<-- Arthritis: nonerosive arthritis involving two or more peripheral joints, characterized by swelling, tenderness, or effusion
<-- Serositis: pleuritis, by convincing history of pleuritic pain, rub heard by physician, or evidence of pleural effusion; or pericarditis documented by electrocardiography, rub heard by physician, or evidence of pericardial effusion
<-- Renal disorder: persistent proteinuria, > 500 mg per 24 hours (0.5 g per day) or > 3+ if quantitation is not performed; or cellular casts (may be red blood cell, hemoglobin, granular, tubular, or mixed cellular casts)
<-- Neurologic disorder: seizures or psychosis occurring in the absence of offending drugs or known metabolic derangement (e.g., uremia, ketoacidosis, electrolyte imbalance)
<-- Hematologic disorder: hemolytic anemia with reticulocytosis; or leukopenia, < 4,000/mm3 on two or more occasions; or lymphopenia, < 1,500/mm3 on two or more occasions; or thrombocytopenia, < 100,000/mm3 in the absence of offending drugs
<-- Immunologic disorder: antibody to double-stranded DNA antigen (anti-dsDNA) in abnormal titer; or presence of antibody to Sm nuclear antigen (anti-Sm); or positive finding of antiphospholipid antibody based on an abnormal serum level of IgG or IgM anticardiolipin antibodies, a positive test result for lupus anticoagulant using a standard method, or a false-positive serologic test for syphilis that is known to be positive for at least 6 months and is confirmed by negative <-- Treponema pallidum immobilization or fluorescent treponemal antibody absorption test
<-- Antinuclear antibodies: an abnormal antinuclear antibody titer by immunofluorescence or equivalent assay at any time and in the absence of drugs known to be associated with drug-induced lupus
Interpretation --> interpretationscore=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9)+(Q10)+(Q11)+(Q12)+(Q13)+(Q14)+(Q15)+(Q16)+(Q17)+(Q18)+(Q19)+(Q20)+(Q21)+(Q22)+(Q23);score>400.1?'SLE':score>10.1?'No SLE or Incomplete SLE':score>.1?'Strong argument against SLE, find other explanation or consult rheumatology':'Very unlikely'
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