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    Portofolio SH

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    Dini Jatiya Anggraini
    Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect multiple organ systems. It is more common in women and those of African descent, with onset usually between ages 15-45. SLE is diagnosed when 4 out of 11 specific clinical criteria are present, including malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, neurologic issues, hematologic issues, renal issues, and immunologic abnormalities. Treatment involves corticosteroids to suppress inflammation, immunosuppressive drugs for major organ involvement, and conservative management for mild cases with NSAIDs and antimalarials.

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    Portofolio SH

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    Dini Jatiya Anggraini
    53 views22 pages
    Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect multiple organ systems. It is more common in women and those of African descent, with onset usually between ages 15-45. SLE is diagnosed when 4 out of 11 specific clinical criteria are present, including malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, neurologic issues, hematologic issues, renal issues, and immunologic abnormalities. Treatment involves corticosteroids to suppress inflammation, immunosuppressive drugs for major organ involvement, and conservative management for mild cases with NSAIDs and antimalarials.

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    Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect multiple organ systems. It is more common in women and those of African descent, with onset usually between ages 15-45. SLE is diagnosed when 4 out of 11 specific clinical criteria are present, including malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, neurologic issues, hematologic issues, renal issues, and immunologic abnormalities. Treatment involves corticosteroids to suppress inflammation, immunosuppressive drugs for major organ involvement, and conservative management for mild cases with NSAIDs and antimalarials.

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    Download as pptx, pdf, or txt
    53 views22 pages

    Portofolio SH

    Uploaded by

    Dini Jatiya Anggraini
    Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect multiple organ systems. It is more common in women and those of African descent, with onset usually between ages 15-45. SLE is diagnosed when 4 out of 11 specific clinical criteria are present, including malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, neurologic issues, hematologic issues, renal issues, and immunologic abnormalities. Treatment involves corticosteroids to suppress inflammation, immunosuppressive drugs for major organ involvement, and conservative management for mild cases with NSAIDs and antimalarials.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 22

    Systemic Lupus

    Erythematosus
    Yudith Annisa Ayu Rezkitha, dr., Sp.PD
    Fakultas Kedokteran
    Universitas Muhammadiyah Surabaya
    SLE
     Autoimmune disease that affects multisystems
     1.5 million cases of lupus
     Prevalence of 17 to 48 per 100,000 population
     Women > Men - 9:1 ratio
     90% cases are women
     African Americans > Whites
     Onset usually between ages of 15 and 45 years,
    but
     Can occur in childhood or later in life
    Clinical Manifestations
     For the purpose of identifying patients in
    clinical studies, a person has SLE if 4 or
    more of the 11 criteria are present,
    serially or simultaneously, during any
    interval of observation. (specificity 95%,
    sensitivity 75%)
     It is important to remember that a patient
    may have SLE and not have 4 criteria.
    Criteria
    1. Butterfly rash 7. Neurologic d/o
    2. Discoid lupus 8. Hematologic d/o
    3. Photosensitivity 9. Renal d/o
    4. Oral ulcers 10.Immunologic: anti-
    5. Arthritis DNA, anti-Sm, false
    (musculosceletal) pos STS
    6. Serositis 11.Anti-nuclear antibody
    1. Malar Rash
    2. Discoid Rash
    4. Oral Ulcers
    5. Arthritis
    (Musculosceletal)
     Polyarthritis, mild to disabling, occurs most
    frequently in hands, wrists, knees. Occurs 90%
     Joint deformities occur in only 10%
     Arthritis of SLE tends to be transitory
     Myositis
    6.Serositis - Pulmonary
     Pleuritis with or without effusion
    Life-threatening manifestations: interstitial
    inflammation which can lead to fibrosis and
    intra-alveolar hemorrhage.
     Also pneumothorax and pulmonary
    Hypertension can occur
    6.Serositis – Cardiac
     Pericarditis: most common cardiac manifestation
     Myocarditis (rare) and fibrinous endocarditis
    (Libman-Sacks) may occur. Steroids plus
    treatment for CHF/arrhythmia or embolic events.
     MI due to atherosclerosis can occur in <35 y/o
    7. Neuro
     Cranial or peripheral neuropathy occurs in 10-15%, it is
    probably secondary to vasculitis in small arteries
    supplying nerves.
     Diffuse CNS dysfunction: memory and reasoning
    difficulty
     Headache
     Seizures of any type
     Psychosis
    8. Heme
     Anemia: usually Normochromic,
    normocytic
     Leukopenia: almost always consists of
    lymphopenia, not granulocytopenia
     Thrombocytopenia
    9. Renal
     Nephritis
     Histologic classification by renal biopsy is
    useful to plan therapy
    10.Immunologic
     Anti-dsDNA IgG: very specific, may
    correlate with disease activity
     Anti-Sm: specific, but only present in 25%
    of cases, does not correlate with activity
    11. ANA (Anti nuclear Antibody)
     ANA: positive in 95% of cases. Pretest
    probability affects interpretation. In PCP setting,
    2% for SLE. In rheum: 30%
     Low Positive (1:160 or lower): SLE likelihood
    <2% (<26% for rheumatologists)
     High Positive (1:320 or higher): SLE likelihood:
    2-17% (32-81% for rheumatologists)
     SLE specific patterns: Rim and Homogenous
    Additional work-up
    - Serum cr. and albumin
    - CBC w/ diff
    - ESR (Laju endap Darah)
    - Complement levels
    - Renal biopsy if warranted
    Treatment
     Treatment plans are based on patient age,
    sex, health, symptoms, and lifestyle
     Goals of treatment are to:
    -prevent flares
    -treat flares when they occur
    -minimize organ damage and
    complications
    High Activity Disease level Tx
     Corticosteroids (Mainstay of SLE treatment)
     To rapidly suppress inflammation
     Usually start with high-dose IV pulse and convert
    to PO steroids with goal of tapering and
    converting to something else.
     Commonly used: prednisone, hydrocortisone,
    methylprednisolone, and dexamethasone
    Immunosuppressives
     Primarily for CNS/renal involvement
     Mycophenolate mofetil (cellcept)
     Azathioprine (imuran): requires several months to be
    effective, effective in smaller percentage of patients
     MTX: for treatment of dermatitis and arthritis, not life-
    threatening disease
     Cyclosporine: used in steroid-resistant SLE, risk of
    nephrotoxicity
     Cyclophosphamide (cytoxan) Almost all trials performed
    on patients with nephritis
    Conservative management
     For those w/out major organ involvement.
     NSAIDs: to control pain, swelling, and fever
     Caution w/ NSAIDS though. SLE pts are at
    increased risk for aseptic meningitis
     Antimalarials: Generally to treat fatigue joint
    pain, skin rashes, and inflammation of the lungs
     Commonly used: Hydroxycholorquine
     Used alone or in combination with other drugs
    THANK YOU

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