Systemic lupus erythematosus diagnosis

Pisetsky DS, Gilkeson G, St Clair EW. Systemic lupus erythematosus Diagnosis and treatment. Med Clin North Am 1997 81 113-129. 

DNA and serum complement (C3) levels. Application to diagnosis and classification of systemic lupus erythematosus. Am. J. Med. 74, 206-216 (1983). 

Smeenk, R., K. Brinkman, H. van den Brink, R. M. Termaat, J. Berden, H. Nossent, and T. Swaak. 1990. Antibodies to DNA in patients with systemic lupus erythematosus. Their role in the diagnosis, the follow-up and the pathogenesis of the disease. Clinical rheumatology 9 100-110. 

Arbuckle MR, James JA, Kohlhase KF, Rubertone MV, Dennis GJ, Harley JB. Development of anti-dsDNA autoantibodies prior to clinical diagnosis of systemic lupus erythematosus. Scand J Immunol 2001 54(1 2) 211-219. 

Thrombotic thrombocytopenic purpura is a rare acute or subacute disease in adults, rather similar to the hemolytic uremic syndrome in children, in which there is systemic malaise, fever, skin purpura, renal failure, hematuria and proteinuria. Hemorrhagic infarcts caused by platelet microthrombi occur in many organs in the brain they may cause stroke-like episodes (Matijevic and Wu 2006) although more commonly there is global encephalopathy. The blood film shows thrombocytopenia, hemolytic anemia and fragmented red cells. The differential diagnosis includes infective endocarditis, idiopathic thrombocytopenia, heparin-induced thrombocytopenia with thrombosis, systemic lupus erythematosus, non-bacterial thrombotic endocarditis and disseminated intravascular coagulation. 

The prevalence of systemic lupus erythematosus in the general population is 40-50 cases per 100 000 persons. Systemic lupus erythematosus has a clear female preponderance (female to male ratio is 9 1). Furthermore, systemic lupus erythematosus is more prevalent in African Americans and Asians than in Caucasians. In addition to constitutional symptoms, such as fever, weight loss, and malaise, nearly every organ system can be involved (e.g. glomerulonephritis, dermatitis, thrombosis, vasculitis, seizures, and non-erosive arthritis). Owing to marked interindividual variability in the clinical expression of the disease, a list of 11 clinical criteria has been proposed, of which 4 must be satisfied for the diagnosis. 

There have been case-reports of a confirmed diagnosis of systemic sclerosis, rheumatoid arthritis, or systemic lupus erythematosus in patients with silicone breast implants (Silverstein et al., 1992 Sanchez-Guerrero et al., 1994 Cuellar et al., 1995 Field Bridges, 1996). However, no association between silicone breast implants and connective tissue disease has been seen in more than... 

Comstock GW, Burke AE, Hoffman SC, Helzlsouer KJ, Bendich A, Masi AT, Norkus EP, Malamet RL, Gershwin ME (1997) Serum concentrations of a tocopherol, p carotene, and retinol preceding the diagnosis of rheumatoid arthritis and systemic lupus erythematosus. Ann Rheum Dis, 56 323-325. 

Tests were performed on Sis Lupus s blood to detect elevated levels of antinuclear antibodies (including antibodies to DNA, antibodies to histone, antibodies to ribonucleopro-teins, and antibodies to nuclear antigens). The tests were strongly positive and, in conjunction with her symptoms, led to a diagnosis of systemic lupus erythematosus (SLE). 

---