Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

1400 Systemic Lupus Erythematosus

■Basic urine studies:

➣Proteinuria

➣Hematuria (RBC casts suggest diffuse proliferative GN)

➣Pyuria in the absence of infection

Specific Tests

■Antinuclear antibody test (ANA) nearly always positive: low titers

non-specific, occur in other autoimmune diseases; specificity for

SLE increases with titer

■Anti-Ro/SSA & anti-La/SSB may be positive in rare “ANA-negative”

lupus

■Highly specific for SLE:

➣antibodies to Sm antigen

➣antibodies to double-stranded DNA

Biopsy

■Renal:

➣mesangial widening, mild hypercellularity most common;

➣significant renal disease shows glomerular lesions (focal segmen-

tal or focal proliferative, diffuse proliferative, membranous, scle-

rosing, or combinations thereof )

➣granular glomerular Ig deposits by immunofluorescence

➣mesangial and subendothelial deposits by electron microscopy

➣mild renal disease may develop into more severe forms

■Other biopsies, e.g., skin, as indicated

differential diagnosis

■rheumatoid arthritis,

■fever of unknown origin

■infection, especially subacute bacterial endocarditis

■fibromyalgia

■systemic vasculitis

management

What to Do First

■Assess disease activity, assess presence /severity of major organ sys-

tem involvement

■Discontinue any drugs that might be responsible for SLE

■Assess for co-morbid fibromyalgia

■Patient education, psychosocial support

■Establish plan for follow-up clinical and laboratory monitoring