Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.
SYSTEMIC LUPUS ERYTHEMATOSES
1
Dr Jayakrishnan MP
PG Resident, Internal Medicine
MGM Medical College, Indore
APPROACH TO POLYARTHRITIS
2
JOINT ANATOMY
3
Determine whether musculoskeletal
complaint is
1. Articular or nonarticular.
2. Inflamatory or noninflamotory.
3. Acute or...
Arthralgia vs Arthritis
• Arthralgia - Pain in joints and is a symptom with an
underlying cause.
Causes: Injury,Infection,...
ARTHRITIS
POLYARTHRITIS
(> 5 joints)
OLIGOARTHRITIS
(2-4 joints)
GOUT
SARCOIDOSIS
LYMES Ds
BECHETS dS
MONOARTHRITIS
(1 joi...
POLYARTHRITIS
INFLAMMATORY
RHEUMATOID
TYPES
RA, SLE
SSc, DM
VIRAL INFECTIONS
RHEUMATOID
VARIANTS
AS, ReA
Ps A
IBD
DEGENERA...
ACR Ad Hoc committee on clinical guidelines, Arthritis rheum 1996; 39: 1
8
SYSTEMIC LUPUS ERYTHEMATOSES
9
DEFINITION
• Autoimmune disease with damage to organs and cells
mediated by autoantibodies and immune complexes.
• Mostly ...
INDIAN STATISTICS
• Prevalence is 3/ 100,000 population (Delhi)
• COPCORD Bhigwan Study(Pune) found incidence of
4 /100,00...
PATHOGENESIS
12
Harrison 19th edition
CLINICAL MANIFESTATIONS
PREVALENCE%
1. Systemic: fatigue ,malaise , fever, wt. Loss ,anorexia 95
2. Musculoskeletal 95
Art...
4. Cutaneous 80
Photosenstivity, Malar rash, Oral ulcers
Alopecia, Discoid rash.
5. Neurological 60
Cognitive disorders, S...
8. Gastrointestinal 40
9. Thrombosis 15
Venous, Arterial
10. Occular 15
Sicca syndrome,Conjuctivitis, Episcleritis, Vascul...
AUTOANTIBODIES IN SLE
Antibody % Clinical Utility
ANA 98 Best screening test
Anti dsDNA 70 Specific for SLE; Correlate wit...
Autoantibodies in SLE
Antibody % Clinical Utility
Anti Histone 70 Drug induced SLE
Antiphospholipid 50 Abortions, Thrombos...
ANA
• Present in 4-5% of healthy population and upto 14% of elderly or
chronically ill patients.
• Its sensitivity is high...
ANA PATTERNS
19
A. Homogenous B. Speckled C. Centromere D. Nucleolar pattern
20
SYSTEMIC LUPUS INTERNATIONAL COLLABORATING
CLINIC (SLICC) CRITERIA FOR CLASSIFICATION OF SLE
A.Clinical Manifestations
1. ...
B. Immunological manifestations
1. ANA
2. Anti- dsDNA
3. Anti Sm
4. Antiphospholipid Ab
5. Low serum complement (C3,C4,CH5...
23
Malar Rash Oral Ulcers
LUPUS NEPHRITIS -ISN &RPS CLASSIFICATION
• Class I Minimal mesangial LN
• Class II Mesangial proliferative LN
• Class III ...
TREATMENT
• Goals of treatment:
- prevent flares
- treat flares when they occur
- minimize organ damage and complications
...
TREATMENT - NON LIFE THREATENING SLE
• NSAIDS
• Antimalarials – Hydroxychloroquine
• Resistent cases – Low dose steroids (...
TREATMENT - LIFE THREATENING SLE
• Glucocorticoids :
- Prednisolone - 0.5-1mg/kg orally or
- Methylprednisolone 1g/d for 3...
TREATMENT
• Other drugs
Chlorumbucil, Methotrexate, Leflunamide
Cyclosporine & tacrolimus
• Biological agents : used in re...
29
Harrison 19th edition
30
Harrison 19th edition
MONITORING OF LUPUS NEPHRITIS
Blood
Pressure
Urine
Analys
is
Prot/Cr
Ratio
Serum
Creatinine
C3/C4
levels
Anti DNA
Active N...
POOR PROGNOSTIC MARKERS
• Male sex
• Anaemia
• Hypoalbuminemia, Hypocomplementemia
• Nephrotic syndrome, Raised serum Cr
•...
THANK YOU
33
RHEUMATOID FACTOR
• RA FACTOR is not specific for RA
• Sensitivity in RA 75- 80%
• May not be positive in early disease.
•...
ANTI-CCP ANTIBODIES
• Sensitivity 75-80%, Specificity 95%
• 40% of seronegative RA are anti-CCP +ve
• Predictor of disease...
Prochain SlideShare
Chargement dans…5
×

Systemic Lupus Erythematosis

7 072 vues

Publié le

SLE - clinical features, diagnosis and treatment

Publié dans : Santé & Médecine
  • A Unique Easy To Follow 5-Step Plan To Eliminating Vitiligo And Related Auto-Immune Skin Disorders Using Proven Holistic Strategies. Learn More ☺☺☺ https://bit.ly/3kTNHDZ
       Répondre 
    Voulez-vous vraiment ?  Oui  Non
    Votre message apparaîtra ici
  • If u need a hand in making your writing assignments - visit ⇒ www.HelpWriting.net ⇐ for more detailed information.
       Répondre 
    Voulez-vous vraiment ?  Oui  Non
    Votre message apparaîtra ici
  • 1 Weird Trick To Easily Cure Vitiligo For Good In As Little As 7 Days - Guaranteed! More Info.. ☞☞☞ https://j.mp/3kTNHDZ
       Répondre 
    Voulez-vous vraiment ?  Oui  Non
    Votre message apparaîtra ici
  • There is a useful site for you that will help you to write a perfect and valuable essay and so on. Check out, please ⇒ www.WritePaper.info ⇐
       Répondre 
    Voulez-vous vraiment ?  Oui  Non
    Votre message apparaîtra ici
  • Writing good research paper is quite easy and very difficult simultaneously. It depends on the individual skill set also. You can get help from research paper writing. Check out, please ⇒ www.HelpWriting.net ⇐
       Répondre 
    Voulez-vous vraiment ?  Oui  Non
    Votre message apparaîtra ici

Systemic Lupus Erythematosis

  1. 1. SYSTEMIC LUPUS ERYTHEMATOSES 1 Dr Jayakrishnan MP PG Resident, Internal Medicine MGM Medical College, Indore
  2. 2. APPROACH TO POLYARTHRITIS 2
  3. 3. JOINT ANATOMY 3
  4. 4. Determine whether musculoskeletal complaint is 1. Articular or nonarticular. 2. Inflamatory or noninflamotory. 3. Acute or chronic. 4. Localised or widespread 4
  5. 5. Arthralgia vs Arthritis • Arthralgia - Pain in joints and is a symptom with an underlying cause. Causes: Injury,Infection,allergic reaction to medication,joint diseases. • Arthritis - Inflammation of one or more joints. 5
  6. 6. ARTHRITIS POLYARTHRITIS (> 5 joints) OLIGOARTHRITIS (2-4 joints) GOUT SARCOIDOSIS LYMES Ds BECHETS dS MONOARTHRITIS (1 joint) TRAUMA INFECTION CRYSTALS TUMOUR 6
  7. 7. POLYARTHRITIS INFLAMMATORY RHEUMATOID TYPES RA, SLE SSc, DM VIRAL INFECTIONS RHEUMATOID VARIANTS AS, ReA Ps A IBD DEGENERATIVE OA METABOLIC GOUT AMYLOIDOSIS 7
  8. 8. ACR Ad Hoc committee on clinical guidelines, Arthritis rheum 1996; 39: 1 8
  9. 9. SYSTEMIC LUPUS ERYTHEMATOSES 9
  10. 10. DEFINITION • Autoimmune disease with damage to organs and cells mediated by autoantibodies and immune complexes. • Mostly affects childbearing age group females. • Female to male ratio 9:1 10 Harrison 19th edition
  11. 11. INDIAN STATISTICS • Prevalence is 3/ 100,000 population (Delhi) • COPCORD Bhigwan Study(Pune) found incidence of 4 /100,000 population/ year. • Mean age of onset is 24.5 years • Female to male ratio 11:1 11 J Indian Rheumatol Assoc 2002 : 10 : 80 - 96
  12. 12. PATHOGENESIS 12 Harrison 19th edition
  13. 13. CLINICAL MANIFESTATIONS PREVALENCE% 1. Systemic: fatigue ,malaise , fever, wt. Loss ,anorexia 95 2. Musculoskeletal 95 Arthralgia/myalgia 95 Nonerosive polyarthritis 60 3. Hematological 85 Anemia, Leucopenia(<4000), Lymphopenia(<1500) Thrombocytopenia(<100000) 13 Harrison 19th edition
  14. 14. 4. Cutaneous 80 Photosenstivity, Malar rash, Oral ulcers Alopecia, Discoid rash. 5. Neurological 60 Cognitive disorders, Seizures, Psychosis 6. Cardiopulmonary 60 Pleurisy, pericarditis, effusions Myocarditis, endocarditis, CAD 7. Renal 30-50 Proteinuria , Cellular casts, Nephrotic syndrome, ESRD CLINICAL MANIFESTATIONS 14 Harrison 19th edition
  15. 15. 8. Gastrointestinal 40 9. Thrombosis 15 Venous, Arterial 10. Occular 15 Sicca syndrome,Conjuctivitis, Episcleritis, Vasculitis CLINICAL MANIFESTATIONS 15 Harrison 19th edition
  16. 16. AUTOANTIBODIES IN SLE Antibody % Clinical Utility ANA 98 Best screening test Anti dsDNA 70 Specific for SLE; Correlate with disease severity Anti-Sm 25 Specific for SLE Anti-RNP 40 MCTD Anti-Ro(SS-A) 30 Predisposes to Subcutaneous Lupus, Neonatal Lupus with Congenital Heart Blocks. Decreased risk of Nephritis Anti-La(SS-B) 10 Decreased risk of Nepritis 16 Harrison 19th edition
  17. 17. Autoantibodies in SLE Antibody % Clinical Utility Anti Histone 70 Drug induced SLE Antiphospholipid 50 Abortions, Thrombosis Antierythrocyte 60 Hemolysis Antiplatelet 30 Thrombocytopenia Antineuronal 60 Active CNS lupus Antiribosomal 20 Depression or Psychosis due to CNS lupus 17 Harrison 19th edition
  18. 18. ANA • Present in 4-5% of healthy population and upto 14% of elderly or chronically ill patients. • Its sensitivity is high for SLE (98%) but specificity is low • Diseases associated : SLE, MCTD, Systemic sclerosis, Drug inudced SLE, Inflammatory myopathies, RA,Sjogrens Thyroid ds, AI hepatitis, PBC, Hep C • Patterns of ANA : Peripheral or rim pattern Homogenous pattern Speckled pattern Centromere pattern Nucleolar pattern. 18 Harrison 19th edition
  19. 19. ANA PATTERNS 19 A. Homogenous B. Speckled C. Centromere D. Nucleolar pattern
  20. 20. 20
  21. 21. SYSTEMIC LUPUS INTERNATIONAL COLLABORATING CLINIC (SLICC) CRITERIA FOR CLASSIFICATION OF SLE A.Clinical Manifestations 1. Acute cutaneous Lupus 2. Chronic cutaneous Lupus 3. Oral or nasal ulcers 4. Non scarring alopecia 5. Arthritis 6. Serositis 7. Renal 8. Neurological 9. Hemolytic anemia 10. Leucopenia 11. Thrombocytopenia 21 Petri M, et al. Arthritis and Rheumatism, Aug 2012
  22. 22. B. Immunological manifestations 1. ANA 2. Anti- dsDNA 3. Anti Sm 4. Antiphospholipid Ab 5. Low serum complement (C3,C4,CH50) 6. Positive direct coombs test • Requirements: >= 4 criteria (atleast 1 in each category) OR Biopsy proven Lupus Nephritis in presence of ANA or Anti ds DNA • Sensitivity 97%, Specificity 84% 22 Petri M, et al. Arthritis and Rheumatism, Aug 2012 SYSTEMIC LUPUS INTERNATIONAL COLLABORATING CLINIC (SLICC) CRITERIA FOR CLASSIFICATION OF SLE
  23. 23. 23 Malar Rash Oral Ulcers
  24. 24. LUPUS NEPHRITIS -ISN &RPS CLASSIFICATION • Class I Minimal mesangial LN • Class II Mesangial proliferative LN • Class III Focal LN (<50% of glomeruli) • Class IV Diffuse LN (≥50% glomeruli) • Class V Membranous LN • Class VI Advanced sclerosing LN(>90% globally sclerosed glomeruli without residual activity) 24 Harrison 19th edition
  25. 25. TREATMENT • Goals of treatment: - prevent flares - treat flares when they occur - minimize organ damage and complications • Treatment plans are based on patient age, sex, health, symptoms and disease severity – Fever, skin, musculoskeletal and serositis - milder disease – CNS and renal involvement - Lifethreatening SLE 25 Harrison 19th edition
  26. 26. TREATMENT - NON LIFE THREATENING SLE • NSAIDS • Antimalarials – Hydroxychloroquine • Resistent cases – Low dose steroids (prednisolone 0.07 to 0.3 mg/kg) - systemic immunosuppressants • Dermatitis: Topical sunscreens, steroids, antimalarials or Tacrolimus. Systemic Dapsone or Thalidomide in resistent cases 26 Harrison 19th edition
  27. 27. TREATMENT - LIFE THREATENING SLE • Glucocorticoids : - Prednisolone - 0.5-1mg/kg orally or - Methylprednisolone 1g/d for 3 days f/b oral therapy 4-6 wks - Maintenance dose 5-10 mg/day • Cytotoxic therapy : - Induction therapy : Cyclophosphamide - 500-750 mg/mt2 monthly for 6 months Mycophenolate mofetil(MMF) 2-3 gm/day - Maintanence therapy : Azathioprine(2mg/kg/d) or MMF(1.5-3 gm/d) 27 Harrison 19th edition
  28. 28. TREATMENT • Other drugs Chlorumbucil, Methotrexate, Leflunamide Cyclosporine & tacrolimus • Biological agents : used in resistent cases Rituximab (Anti CD20 Ab) Belimumab (Anti BLyS) 28
  29. 29. 29 Harrison 19th edition
  30. 30. 30 Harrison 19th edition
  31. 31. MONITORING OF LUPUS NEPHRITIS Blood Pressure Urine Analys is Prot/Cr Ratio Serum Creatinine C3/C4 levels Anti DNA Active Nephritis 1 1 1 1 2 3 Previous active nephritis,none currently 3 3 3 3 3 6 No prior or current nephritis 3 6 6 6 6 6 31Arthritis Care Res (Hoboken). 2012 June ; 64(6): 797–808. doi:10.1002/acr.21664
  32. 32. POOR PROGNOSTIC MARKERS • Male sex • Anaemia • Hypoalbuminemia, Hypocomplementemia • Nephrotic syndrome, Raised serum Cr • HTN • aPL Ab 32
  33. 33. THANK YOU 33
  34. 34. RHEUMATOID FACTOR • RA FACTOR is not specific for RA • Sensitivity in RA 75- 80% • May not be positive in early disease. • It is not a screening test for RA. • Conditions associated with RA Factor : - Rheumatologic diseases: RA, SLE, sjogren’s, MCTD, myositis, cryoglobulinemia - Infections: SABE, TB, syphilis, hepatitis B&C - Present in 1-5% of healthy population 34 Harrison 19th edition
  35. 35. ANTI-CCP ANTIBODIES • Sensitivity 75-80%, Specificity 95% • 40% of seronegative RA are anti-CCP +ve • Predictor of disease severity • Present months prior to disease 35 Harrison 19th edition

×