Lupus Erythematosus Dr. Mohamed nasr
Jan 15, 2016
Lupus Erythematosus
Dr. Mohamed nasr
Types of Lupus:
Cutaneous (skin) lupus primarily affects the skin but may involve the hair and mucous
membranes also commonly called discoid lupus
Systemic lupus erythematosus (SLE) affects any system in the body
Drug-induced lupus erythematosus (DILE) Side effect of long term use of certain medications Symptoms overlap with those of SLE
Neonatal lupus very rare acquired from the passage of maternal autoantibodies
Cutaneous Lupus
ACUTE: Typical photosensitive malar rash when acute Highly associated with systemic LE (almost 100%)
SUBACUTE: This variant is psoriasiform or annular ~50% of these patients will meet criueria for SLE
CHRONIC: ie Discoid Lupus Most patients (85-90% never develop systemic lupus)
Systemic Lupus Erythematosus Chronic
autoimmune disease Most common form
of lupus Autoantibodies
produced by own immune system
recognize own DNA as foreign
Lupus “wolf”
Understanding the causes:
Unknown Possible Factors:
genetics environmental hormonal
May explain why lupus occurs more frequently in females than in males
NOT infectious
Screening and Diagnosis:
Difficult Usually takes months to even years Laboratory tests:
Antinuclear antibody (ANA) test that detects the presence of autoantibodies that attack your own cells
blood tests for anemia, low white-cell count, abnormalities in organ function
urinalysis electrocardiogram or echocardiogram to check the
heart chest x-ray
Eleven Criteria Used for the Diagnosis of Lupus:
Malar Rash Rash over cheeks
Discoid Rash Red raised patches
Photosensitivity Reaction to sunlight
Oral Ulcers Ulcers in nose or mouth
Arthritis Two or more joints
Serositis Pleuritis or pericarditis
Eleven Criteria cont…
Renal Disorder Excessive protein in the urine or cast.
Neurologic Disorder Seizures
Hematologic Disorder Hemolytic anemia or leukopenia
Immunologic Disorder Positive anti-double stranded anti-DNA test
Antinuclear Antibody Positive test
Why organs are attacked:
Due to autoantibodies Also referred to as anti-nuclear antibodies Antibodies produced by the immune system Attack the RNA and DNA in the nucleus of
own cells
Systems Affected
Musculoskeletal system -- avascular necrosis -- muscle inflammationKidney systemNervous system -- seizures -- nerve paralysis -- severe depression -- psychosis -- strokesBlood and Lymph system -- anemia -- thrombocytopenia -- leucopenia
Systems Affected
Stomach, Intestines, Liver, and Associated Organs -- ulcers -- abdominal painsSkin and Hair -- rash and alopeciaHeart and Blood Vessels -- pericarditis -- arthrosclerosis -- spasms of the arteryLungs -- pleurisy, pneumonia, and pleural effusionEyes -- rarely involved except for retina
The simplest of treatments include:
1- Anti-inflammatory drugs like Aspirin.
2- Anti- malarial drugs.
3- Immunosuppressive medications.
4- Corticosteroids.
Subacute Cutaneous Lupus Erythematosus
Widespread, non-scarring but often photosensitive rash.
Annular or papulosquamous morphology.Mild systemic disease common but renal
involvement rare.Positive ANA in most patients, but anti-nDNA
uncommon.Anti-Ro in two thirds patients.
Subacute Cutaneous Lupus
Discoid Lupus Erythematous (DLE)
Most scarring and chronic form of cutaneous lupus.
Discoid shaped plaques with white scale, with time, lesions become atrophic.
Can lead to scarring alopecia.Few patients meet criteria for SLE (6%).
The characteristics of DLE lesions:
1. Persistent localized erythema.
2. Adherent scales related to the dilated follicles.
3. Follicular plugging.
4. Redness & telangiectasia of the border.
5. Atrophy & scarring of the center.
Follicular Plugging
Diagnosis = lupus band test
Presence of IgG & C in linear pattern at dermo-epidermal junction below lamina densa in involved sun-exposed skin only.
Treatment:
Treat with intralesional or topical steroids, sun avoidance & antimalarial if severe or large areas involved.