inpatient / rheumatology and immunology

Systemic Lupus Erythematosus (SLE)

Last Updated: 1/19/2023

# Lupus / SLE

-- Chart Check: *** previous flares and complications (nephritis, strokes)
-- Can't Miss: *** lupus nephritis, CNS involvement
-- Initial Treatment to Consider: *** discuss with rheum consultants the need for steroids in flares

-- History: *** pregnancy-loss, nephritis, seizure, stroke, prior treatments
-- Clinical: ***  fever, weight loss, fatigue, sicca, esophagitis, symmetric nondeforming arthritis, cytopenias, nephritis, e/o stroke or CNS dx, pericarditis
-- Exam: *** malar rash, oral/nasal ulcers, cheilitis, alopecia, Raynaud's,
-- Data: *** ANA, dsDNA (active dx), anti-Sm (positive in remission), anti-RNP, anti-SSA/SSB, antiphospholipid Ab, C3/C4, CBC, BMP, DAT, UA/UPCR
-- Etiology/DDx: *** drug-induced, undifferentiated connective tissue disease

The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.

-- New diagnosis - f/u ANA, dsDNA, anti-Sm, anti-RNP, anti-SSA/SSB, antiphospholipid Ab, C3/C4, DAT, UA/UPCR
-- Screen for antiphospholipid
-- If c/f lupus nephritis - renal biopsy needed

-- Continue home *** (HCQ, steroid, mycophenolate, MTX, azathioprine, etc)
-- Flares - *** IV steroids and other immunosuppressive agents - d/w rheum consultants
-- Lifestyle - smoking cessation, aerobic exercise, avoid UV light

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Clinical Pearls

  • ANA titer > 1:80 have 98% sensitivity for SLE
  • anti-dsDNA is highly specific for SLE, correlates with disease activity
  • anti-Smith - highly specific for SLE, present in remission 
  • Patients with lupus have double the cardiovascular risk compared to those without
  • Lupus nephritis is caused by the deposition of immune complexes that leads to the thickening of mesangium, capillary walls, and GBM - can be either nephritic or nephrotic 
  • Infections are responsible for 25-50% of deaths in patients with SLE

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