DR Medhat MRCP

J. Neurological :
1. Lupus cerebritis (seizures).
2. Psychosis.
3. Cranial neuropathy & peripheral neuropathy.
• Sure diagnostic criteria of SLE: any 4 criteria of the following confirms the diagnosis
1) Malar flush.
2) Discoid rash.
3) Photosensitivity.
4) Oral ulcers.
5) Serositis (pleurisy , pericarditis).
6) Arthritis.
7) Nephritis.
8) Lupus (cerebritis ,psychosis).
9) Hematological (pancytopenia).
10) ANA +ve.
11) Anti ds-DNA, anti-sm +ve.
• Evidences of active lupus :
Clinically :
- Fever with rash.
- Acute inflammatory symmetrical polyarthritis.
- Purpuric eruption.
Laboratory :
- Hypocomplementemia (low C3 & C4).
- High ESR (commonly > 100) , normal CRP.
- Rising titre of anti ds-DNA.
- Active urinary sediment (proteinuria & microscopic hematuria)+ RPGN
(cerescentic GN) with impaired renal functions .
• Investigations :
Immunology
o 99% are ANA positive.
o 20% are rheumatoid factor positive.
o Anti-dsDNA: highly specific (> 99%), but less sensitive (70%)
o Anti-Smith: most specific (> 99%), sensitivity (30%).
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