Lupus erythematosus

Lupus erythematosus (also known as systemic lupus erythematosus or SLE) is an autoimmune disorder in which antibodies are created against the patient's own DNA. It is named for the Latin lupus, meaning "wolf," due to the butterfly-shaped rash that the disease classically creates on the cheek which medieval people believed to resemble a wolf bite.

Classification

The American College of Rheumatology has established eleven criteria in 1982http://www.rheumatology.org/publications/classification/index.asp?aud=mem, which were revised in 1997http://www.rheumatology.org/publications/classification/SLE/1982SLEupdate.asp?aud=mem, as a classificatory instrument to operationalise the definition of SLE in clinical trials. They were not intended to be used to diagnose individual patients and do not do well in that capacity. A patient must present with four of the eleven criteria, either simultaneously or serially, during a given period of observation, to be classified as having SLE ? for the purposes of inclusion in clinical trials.

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• Malar rash (rash on cheeks)
• Discoid lupus (red, scaly patches on skin which cause scarring)
• Photosensitivity (adverse reaction to sunlight)
• Mouth ulcers
• Arthritis
• More than 0.5g per day protein in urine, or cellular casts seen in urine under a microscope.
• Seizures or psychosis
• Pleuritis (inflammation of the membrane around the lungs) or pericarditis (inflammation of the membrane around the heart)
• Hemolytic anemia (low red blood cell count), leukopenia (low white blood cell count), lymphopenia (low lymphocyte count) or thrombocytopenia (low platelet count)
• Anti-DNA antibody, anti-Sm antibody or false positive serological test for syphilis or antiphospholipid antibody positivity
• Positive fluorescence antinuclear antibody test (positive ANA)

Some patients may have SLE without four criteria and SLE is associated with manifestations other than those listed in the criteria. Dr Graham R.V. Hughes, an authority on lupus in the UK, has published alternative criteria to diagnose SLEhttp://www.lupus-support.org.uk in 1982.

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