Contents
- 1 Diagnosis / Suspicion of SLE is based on
- 2 Saga History (Saga) by SLE (1includes SLICC Criteria, 2ACR Criteria)
- 3 Other manifestations
- 4 Clinical examination at SLE
- 5 Blood and urine samples
- 6 X-ray examination of lungs
- 7 What we should also ask the patient about
- 8 Follow-up
- 9 Norwegian Directorate of Health (Supervisor for referrals)
Diagnosis / Suspected SLE is based on
- Disease history (check SLICC criteria below)
- Medical investigation and findings
- Laboratory tests
- Tissues from kidneys (kidney biopsy) if kidney involvement
- SLE begins most commonly in women of childbearing age, more often among people from Asia and Africa
- Differential diagnoses, please see here
Disease history (anamnesis) at SLE (Syndrome)1included in SLICC criteria, 2ACR criteria)
- Time of
- Disease debut
- Diagnosis and debut symptoms
- Disease debut
- 1Acute or chronic skin changes (eczema)
- 1,2Frequent mouth ulcer
- 1Alopecia (stinging hair loss)
- 1,2Arthritis (small joint is most common)
- 1,2Serotonitis (pleuritis, pericarditis)
- 1,2Kidney disorders (proteins and blood in the urine by glomerulonephritis)
- 1,2Neurological (cramps, psychosis)
- 1,2blood Cells
- Hemolytic anemia (high LD and reticulocytes, low haptoglobin)
- Leukopenia
- Thrombocytopenia
- 1,2Antibodies
- ANA
- DNA
- Sm
- Antifosfolipid antibodies (Lupus Anticoagulant, Cardiolipin, Beta-2-Glycoprotein)
- * Low complement factors
- C3 and / or C 4
- 2Butterfly Rash (on the cheeks) **
- 2Diskoid rash**
- 2Sun rash (Photosensitivity **
Other manifestations
- Affected general condition: Night sweat / subfebril / fever?
- Antifosfolipid syndrome (Secondary)
- Thromboses: venous and arterial?
- Miscarriages?
- Joint
- Yesccoud joints (with errors) (2%)
- Erosive Arthritis (Usurer) (5%)
- Heart
- Endocarditis (Libman-Sacks)
- Pulmonary hypertension (rarely at SLE)
- Nervous System
- Central nervous (CNS) affection:
- Headache/Cognitive disorders/ Apoplexy / Epilepsy /
- Findings in MRI and MRI Angiography, SPECT, PET / CT
- Polynesia / Peripheral pares
- Central nervous (CNS) affection:
- Dry mucous membranes
- Sicca phenomena (Secondary Sjögren's syndrome)
- Raynaud's phenomenon?
- Autoantibodies
- RNP (MCTD?)
- SSA / B (subacute cutaneous lupus, primarily Sjøgrens syndrome?)
- High Sedimentation rate (ESR), low CRP
- Weight loss last 3-6 months
- Immunosuppressive treatment until now
- Prednisone
- Plaquenil
- Azathioprine
- Methotrexate
- Mycophenolate (CellCept)
- Cyclophosphamide
- Planned pregnancy?
Clinical examination at SLE
- Blood pressure and pulse
- Heart and lungs (auscultation)
- Skin and hair
- Joint
- Edema (kidney)
- Neurological
Blood and urine samples
- The sedimentation rate (ESR) is often high
- CRP almost normal, but increases with infection, arthritis and pulmonary (pleurisy) or heart bag inflammation (pericarditis)
- Cell counts (Hemoglobin, lymphocytic leukocytes, platelets)
- Complement factors C3 and C4
- Urine with signs of glomerulonephritis (proteins, blood, protein / creatinine, cylinders)
- Blood tests that take initially, then rarely
- Antibody samples (in blood) ANA, ENA, DNA antibody, anti C1q
- Antifosfolipid antibodies (Lupus anticoagulant via hematological / coagulation laboratory), α-cardiolipin and beta-2 glycoprotein (β-2GP).
X-ray examination of lungs
- Exclude signs of manifestations in the pleura / pericard
- «Shrinking lung» with diaphragm height
What we should also ask the patient about
- How strong is your pain today (scale 0-100)?
- How strong is the fatigue today (scale 0-100)?
- How do you perceive your disease activity today (scale 0–100)?
- (The doctor can also add his assessment of the disease activity, scale 0-100)
Follow-up
- All patients with aktiv SLE should be followed up by both a specialist and a GP
- The frequency of controls will depend on the disease activity, complications and medications used
- If new symptoms, check keywords for medical history (see above)
- Clinical examinations as mentioned above
- Blood and urine are checked
- Antibody and complement factors need not be checked every time
- By pregnancy close monitoring of rheumatologists and obstetricians should be organized as soon as possible
- Validated targets for disease activity can be done at SLEDAI
0 Nydalen, 0424 OSLO. The ward can also receive patients from the rest of the country when the capacity allows it.
Norwegian Directorate of Health (Supervisor for referrals)
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