autoimmune disease ,primarily affecting the adult female,great imitator

1. Systemic Lupus Erythematosus

2. Who can see the pain within my
heart?

3. COMPARE……..

4. Epidemiology

5. Clinical feature
Manifestation Prevalence(%)
Fatigue/malaise/fever 95
Cutaneous 80
hematologic 85
Neurologic 60
Cardiopulmonary 60
Renal 30
Gastrointestinal 40
Thrombosis 15

6. Investigation:
Screening:
ANA
Specific:
Anti-ds DNA
Diasease activity;
Complement, Anti ds DNA, active sediment in
urine

7. SlICC clinic criteria for
SLE
Clinical manifestation Immunologic manifestation
 Acute cutaneous
 Chronic cutaneous
 Oral ulcer
 Serositis
 Alopecia
 Synovitis
 Renal
 Neurologic
 Hemolytic anemia
 Leucopenia
 thromcytopenia
 ANA
 Anti-ds DNA
 Anti-Sm
 Antiphospholipid
 Low serum complement
 Positive DCT
4 CRITERIA AT ALEAST 1 CRITERIA
EACH FROM CLINICAL AND
IMMUNOLOGICAL
BIOPSY PROVEN LUPUS
NEPHRITIS+ANA/ANTI DS DNA

8. Treatment
Not life or
organ
threatening
Life or organ
threatening
 High dose
glucocorticoids
Addition of immunosuppressive
Mycophenolate/cyclophosphamide

9. What about ?
 hydoxychlroquinine

10. Scleroderma

11. Definition
 Connective tissue disorder, involve multisystem
 Characterised by skin thickening

12. Epidemiology
 Female predominant(4.6:1)
 Peak age of onset: 30-50 years

13. Types of systemic sclerosis
Characterstics Limited cutaneous Diffuse cutaneous
Skin involvement Limited distal to elbow Diffusely involve
Raynauds
phenomenon
Precedes the skin
involvement
Coincident
ILD Mild Common and severe
Renal crisis Rare Common
Antibodies Anticentromere Ab Anti-topoisomerase
Ab.

14. Clinical features

15. Raynaud phenomenon

16. INVESTIGATION
Diagnosis Supportive
ACA: limited cutaneous SSC
Anti-toposisomerase I:
Diffuse cutaneous SS
Full thickness skin biopsy
 ECHO:
 PFT:
 UGI endoscopy:
 Nail cappillaroscopy:

17. Treatment
Definative supportive
 Disease modifying therapy
 Glucocorticoids:only if
indicated
 Cyclophosphamide:for ILD
 Mehtotrexate/mycophenol
ate mofetil:little benefit
 Antifibrotic therapy:D-
penicillamine
 Vascular therapy:Calcium
channel blocker
 gastrointestinal :
 Pulmonary artery
hypertension:
 Renal crisis:

18. Treatment
 No any treatment to significantly alter the
course the natural history of disease.

19. Thank you