Systemic Lupus Erythematosus (Lupus; SLE)

American College of Rheumatology Criteria for diagnosis [modified]

* Antinuclear Antibodies (ANA)
  • ≥1:160 Sensitive !     >1:640 fairly Specific

And ≥3 of the Following (perhaps even ≥4, without the ANA)

*  Malar Rash [see pictures below]
  • Fixed erythema over cheekbones
  • Spares nasolabial folds
*  Discoid Rash  [see pictures below]
  • Red, raised, scaly patches

*  Photosensitivity

* Oral / Nasal Ulcers  (usually painless)
  • Observed objectively
* Arthritis
  • ≥2 joints, objectively observed
* Serositis
  • Pleuritis (friction rub/effusion/good Hx of episodic pleuritic CP)
  • Pericarditis (friction rub / EKG changes / echo)

* Seizure OR Psychosis

* Cytopenias on the CBC (any of following):
  • Anemia (hemolytic, w/ reticulocytosis)
  • Lymphopenia: <1500 absolute Lymphs on 2 occasions
  • Leukopenia: <4000 WBCs on 2 occasions
  • Platelets: <100,000
* Urinalysis (either of following):
  • >3+ Protein (persistent)
  • Casts
* Immunologic Findings (any of following)
  • Anti-ds DNA
  • Anti-Smith
  • Anti-Phospholipid Abs
  • False + RPR [x6 months, confirmatory test negative)
  • ↓ C3 and C4 common (not part of diagnostic paradigm)
 NOTE:  Pt’s may have SLE without fulfilling criteria:
  • Positive renal biopsy diagnostic
  • Dx Criteria ? more useful in research vs. clinical
  • Pts develop additional Sx over time

See posting Polyarthralgias.

PICTURES:

Malar Rash  [NOTE: does Not cross nasolabial fold]

                

Discoid Rash