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Systemic Lupus Erythematosus
Who can see the pain within my heart?
COMPARE……..
Epidemiology
Clinical feature
Manifestation Prevalence(%)
Fatigue/malaise/fever 95Cutaneous 80hematologic 85Neurologic 60Cardiopulmonary 60Renal 30Gastrointestinal 40
Thrombosis 15
Investigation:
Screening: ANA
Specific:Anti-ds DNA
Diasease activity;Complement, Anti ds DNA, active
sediment in urine
SlICC clinic criteria for SLEClinical manifestation Immunologic
manifestation Acute cutaneous Chronic cutaneous Oral ulcer Serositis Alopecia Synovitis Renal Neurologic Hemolytic anemia Leucopenia thromcytopenia
ANA Anti-ds DNA Anti-Sm Antiphospholipid Low serum
complement Positive DCT4 CRITERIA AT ALEAST 1
CRITERIA EACH FROM CLINICAL AND IMMUNOLOGICAL
BIOPSY PROVEN LUPUS NEPHRITIS+ANA/ANTI DS DNA
Treatment
Not life or organ
threatening
Life or organ threatening
High dose glucocorticoids
Addition of immunosuppressive
Mycophenolate/cyclophosphamide
What about ?
hydoxychlroquinine
Scleroderma
Definition
Connective tissue disorder, involve multisystem
Characterised by skin thickening
Epidemiology
Female predominant(4.6:1)
Peak age of onset: 30-50 years
Types of systemic sclerosisCharacterstics Limited
cutaneousDiffuse cutaneous
Skin involvement Limited distal to elbow
Diffusely involve
Raynauds phenomenon
Precedes the skin involvement
Coincident
ILD Mild Common and severe
Renal crisis Rare Common
Antibodies Anticentromere Ab Anti-topoisomerase Ab.
Clinical features
Raynaud phenomenon
INVESTIGATION
Diagnosis SupportiveACA: limited cutaneous
SSC
Anti-toposisomerase I: Diffuse cutaneous SS
Full thickness skin biopsy
ECHO:
PFT:
UGI endoscopy:
Nail cappillaroscopy:
Treatment
Definative supportive Disease modifying
therapy
Glucocorticoids:only if indicated
Cyclophosphamide:for ILD
Mehtotrexate/mycophenolate mofetil:little benefit
Antifibrotic therapy:D-penicillamine
Vascular therapy:Calcium channel blocker
gastrointestinal :
Pulmonary artery hypertension:
Renal crisis:
Treatment
No any treatment to significantly alter the course the natural history of disease.
Thank you