Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (19 page)

   Photosensitivity

   Oral ulcers

   Nonerosive arthritis, involving two or more peripheral joints

   Pleuritis or pericarditis

   Renal disorder, manifested by persistent proteinuria or cellular casts

   Neurologic disorder: seizures or psychosis

   Hematologic disorder: hemolytic anemia, leukopenia, lymphopenia, or thrombocytopenia

   Immunologic disorder: anti-dsDNA antibody, anti-Sm antibody, or positive finding of antiphospholipid antibodies

   Positive antinuclear antibody at any point in time and in the absence of drugs

   Who Should Be Suspected?

   Likely patients are individuals presenting with constitutional symptoms (fatigue, fever, weight loss) associated with features of multisystem or, in some cases, a single organ involvement. These features may include rash, photosensitivity, arthralgia or arthritis, anemia, serositis, nephritis, mild peripheral edema, or neurologic symptoms such as seizures, psychosis, or peripheral nephropathy.

   SLE affects 10 times as many women as men. Disease onset commonly occurs between 20 and 40 years of age.

   A variant of lupus, called drug-induced lupus erythematosus, may be the result of treatment with procainamide, hydralazine, chlorpromazine, quinidine, or, more recently, anti-TNF alpha. Patients typically present with skin and joint manifestations but rarely have renal or neurologic features. It is a self-limited condition in most cases, and symptoms usually recede after discontinuing the drug.