2025 – PAGE 422 – RHEUMATOLOGY

SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

Signs of systemic lupus erythematosus (SLE) include arthralgias, fatigue, malar rash, discoid lesions, photosensitivity, oral/nasal ulcers (if oral, painless and at hard palate), arthritis, hematologic abnormalities, ANA antibodies (most sensitive but not very specific), anti-DNA antibodies (next most sensitive), anti-Smith antibodies (most specific/diagnostic), +RPR, serositis of pleura or pericardium, psychiatric or neurologic issues. Other signs include fever, weight loss, hemolysis, and clots. Some other adverse effects of SLE are listed below.

• LUPUS NEPHRITIS: Associated with a high anti-DNA and low C3, C4, and CH50.
  • PEARL/REMINDER: PSGN and MPGN typically only have a low C3.
• LUPUS CEREBRITIS: Associated with microischemia, cerebrovascular disease, seizures and can result in neuropsychiatric manifestation from lupus itself. Psychologic testing can sometimes help. Unlike steroid psychosis, though, CT and MRI imaging may reveal CNS lesions, EEG may be abnormal, CSF findings may be present, and the pure neurologic findings (stroke, seizures, meningitis, optic neuritis, etc.) would only be found in lupus cerebritis.
  • PEARL: Steroid psychosis usually occurs after being on steroids for a prolonged period of time. Symptoms will include more of the “psychiatric” flavor rather than the “neurology” flavor, and could include mania, hypomania or psychosis. Do not confuse such behavior with cerebritis.
• TREATMENT: NSAIDS if mild. Steroids, hydroxychloroquine, methotrexate, etc. if severe.
  • PEARL: There’s quite a bit of information above. In order to make a diagnosis of SLE, look for AT LEAST 4 SYMPTOMS/SIGNS, preferably from different categories (skin, heme, markers, etc.).