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Drug Induced Lupus
Chronic Discoid Lupus
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Systemic Lupus Erythematosus
- facial rash
- discoid rash
- photosensitivity
- oral / nasopharyngeal ulcerations
- non-erosive arthiritis
- serositis
- renal disease
- haematological
- neurological
- immunological
- ANA positive
Causes
- idiopathic
- drugs
- penicillamine
- hydralazine
- procainamide
Presentation
- young
- female
- precipitating event?
History
- arthralgia
- rash
- General
- weight loss
- malaise
- fever
- Joints
- Skin
- facial rash
- photosensitivity
- Raynaud's
- discoid rash
- Respiratory
- pleuritic chest pain
- shortness of breath
- Renal
- treatment for renal failure
- dialysis
- Neuro
- fits
- stroke-like episodes
PMH
- Recurrent abortions
- Previous DVT / PE
- History of Depression / Psychosis
FHx
DHx
SHx
Examination
General
- Pallor
- Pyrexia
- lymphadenopathy
- vasculitic rash
Hands
- Raynaud's
- Nail bed infarcts
- finger spindling
Face
- butterfly rash
- nasopharyngeal ulceration
CVS
Respiratory
Musculoskeletal
- often normal on examination
- spindling of fingers
- severe arthritis
CNS
- mononeuritis
- psychosis
- depression
- CVA
Urine
Investigations
- FBC
- anaemia (of chronic disease)
- leucopenia
- ESR
- U&E
- Antibodies
- Anti-nuclear antibody (ANA)
- dsDNA
- +ve in 50% but specific for SLE
- anti-ssRNA, anti-Ro, anti-La
- Complement
- Renal biopsy
Complications
- renal damage
- class 1 - normal or minimal change
- class 2 - mesangial lupus nephritis
- class 3 - focal proliferative glomerulonephritis
- class 4 - diffuse proliferative glomerulonephritis
- class 5 - membranous glomerulonephritis
- class 6 - interstitial and tubular nephritis
Treatment
Differential Diagnoses
Prognosis
- death due to
- infection
- cardiovascular disease
- infection
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