Attached.

Dr. Aliaa Omar El-Hady
Consultant of Rheumatology & Rehabilitation
Mataria Teaching Hospital

The assessment of SLE is marked by four
components:
1. accurate diagnosis
2. monitoring of disease activity
3. recording of accumulated damage
4. integration of these with the patient’s own
perceptions of health status and quality of
life.
Multiple standardized measures have been
developed for each component, many of which
are effective in routine clinical practice.

• Detailed
history,
thorough
physical
examination, and appropriate use of
laboratory and radiographic studies are
required at each clinic visit to fully assess SLE.
•Quarterly follow-up is recommended even for
the stable SLE patient.
•With the complex phenotype and variable
disease course of SLE, all four components are
equally important and essential in improving
the morbidity, mortality, and quality of life in
SLE.

•Fatigue, fever, arthralgia, and weight changes
are the most common symptoms in new cases
or recurrent active SLE flares.
•Fatigue, the most common constitutional
symptom associated with SLE, can be due to
active SLE, medications, lifestyle habits, or
concomitant
fibromyalgia
or
affective
disorders.
•SLE-specific fatigue or fever generally occurs
in concert with other clinical markers.

•Fever may reflect active SLE, infection, and
reactions to medications (ie, drug fever).

•Always exclude an infectious etiology; patients with SLE are
considered immunocompromised and are therefore at
higher risk for developing infections and complications.
•Most infections are bacterial in origin, but clinicians should
always consider the possibility of atypical and opportunistic
infections, particularly when these individuals are receiving
immunomodulating or immunosuppressive therapy.
•Careful history taking may help differentiate between the
potential causes of fatigue or fever.
•Note that an acute infectious process may also trigger SLE
and that the two can occur concomitantly.
•Weight loss may occur in patients with active SLE.

•Weight gain

may also be due to corticosteroid
treatment or active disease, such as nephrotic syndrome
(with anasarca) or myocarditis.

Malar Rash
•The classic lupus butterfly rash
•manifests acutely as an erythematous, elevated
lesion, pruritic or painful, in a malar distribution,
•commonly precipitated by exposure to sunlight.
•The rash may last days to weeks
•Is commonly accompanied by other inflammatory
manifestations of the disease.

The acute butterfly rash should be differentiated
from other causes of facial erythema:
•Rosacea
•Seborrheic
•Atopic
•contact dermatitis
•glucocorticoid-induced dermal atrophy
•flushing.

The sparing of the nasolabial folds and the absence
of discrete papules and pustules help to differentiate
this condition from acne rosacea (including
glucocorticoid-induced rosacea).

•Other acute cutaneous lesions include generalized
erythema and bullous lesions.
•The rash of acute cutaneous lupus erythematosus
can be transient and heal without scarring.

Subacute cutaneous lupus erythematosus (SCLE)
•is not uniformly associated with SLE.
•~ 50% of affected pts have SLE, and ~ 10% of pts with SLE
have this type of skin lesion.
•Patients with SCLE may present with annular or
psoriasiform skin lesions
•is strongly associat. with anti-Ro (SS-A) & anti-La (SS-B) abs
•have a high incidence of photosensitivity
•rarely can present with erythema multiforme–like lesions
(Rowell's syndrome).

• SCLE

lesions begin as small, erythematous, slightly scaly
papules that evolve into either a psoriasiform
(papulosquamous) or annular form.
•The latter lesions ...