Keyword for investigation, referral and journal writing at SLE 4.56/5 (9)

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 Diagnosis / Suspected SLE is based on

Disease history (anamnesis) at SLE (Syndrome)1included in SLICC criteria, 2ACR criteria)

  • Time of
    • Disease debut
      • Diagnosis and debut symptoms
  • 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
  • * Low complement factors
    • C3 and / or C 4
  • 2Butterfly Rash (on the cheeks) **
  • 2Diskoid rash**
  • 2Sun rash (Photosensitivity **

Other manifestations

  • 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

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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