2. Systemic Lupus Erythematosis
Definition: Inflammatory multisystem disease of unknown cause, with diverse clinical and laboratory manifestations and variable course and prognosis…..???

3. Aetiology
Unknown
Genetics - 10%
Infective
Hormonal
Sunlight
Drugs

4. Who gets Lupus? UK 12/100 000 Sweden 39/100 000 Cape Town 50/100 000
Women in reproductive years:
female: male :1

5. Symptoms constitutional 73% arthralgia 77% skin 57% arthritis 56%
kidney 44%
Raynaud’s 33%
lymph nodes 25%
CNS 24%
pleurisy 23%
pericarditis 20%
mouth ulcers 18%
vasculitis 10%
myositis 7%

6. Organ involvement Skin: butterfly rash, diffuse rash, vasculitis
Joints: hands, wrists, knees
Serositis: pleural/ pericardial
Kidney: mild inflammation to severe destruction
Lung: pneumonitis, haemorrhage, hypertension
Cardiac: myocarditis, endocarditis, CAD
Haematologic: anaemia, low WCC, low platelets

7. Neuropsychiatric lupus
CNS
Epilepsy, CVA, cranial N, myelitis
Peripheral
Peripheral neuropathy, mononeuritis
Psychiatric
Psychosis
Organic brain syndrome
Depression

15. Criteria for classification (1982)
Malar rash
Discoid rash
Photosensitivity
Oral ulcers
Arthritis
Serositis
Renal
Neurology: seizures or psychosis
Haematology: anaemia, WCC <4000, plt <100
Immunology:ds DNA
(+) ANF

16. Useful antibody tests Antinuclear Factor (ANF) Anti-DNA Antibody (ADA)
Anti-centromere Antibody
Anti-topoisomerase1 Antibody
Extractable Nuclear Antigens Sm
RNP
Ro/ La
Antiphospholipid Antibody(ACLA)

17. Reasons for referral to a Rheumatologist
To confirm a diagnosis
To assess disease activity and severity
To provide a general management plan
To manage uncontrolled disease
To manage life-threatening/ organ disease
To manage/ prevent treatment toxicities
Special circumstances, eg. Pregnancy + APL

18. Connective Tissue Diseases
Systemic Lupus Erythematosis
Lupus Variants
Progressive Systemic Sclerosis
Polymyositis/ Dermatomyositis
Vasculitis
Primary
Secondary