SLE Overview_Diagnosis
Diagnosis is clinical and may be made with ≥ 4 classification criteria present
Criteria is (96% specific, 96% sensitive)
any 4 or more of 11 criteria, serially or simultaneously, during any interval of observation
1. malar (butterfly) rash - fixed erythema, flat or raised, over malar eminences, tending to spare nasolabial folds
2. discoid lupus - erythematous raised patches with adherent keratotic scaling and follicular plugging, atrophic scarring may occur
3. photosensitivity - skin rash resulting from unusual reaction to sunlight
4. oral or nasopharyngeal ulcers - usually painless, observed by physician
5. non-erosive arthritis - involving 2 or more peripheral joints with tenderness, swelling or effusion
6. serositis - pleuritis (pleuritic pain, pleuritic rub or pleural effusion) or pericarditis (on ECG, rub or pericardial effusion)
7. renal involvement - persistent proteinuria (> 500 mg/day or 3+ on dipstick) or cellular casts (red cell, hemoglobin, granular, tubular or mixed)
8. seizures or psychosis without other organic cause
9. hematologic disorder
hemolytic anemia with reticulocytosis, OR
WBC < 4,000 at least 2 times, OR
absolute lymphocyte count < 1,500/mm3 at least 2 times, OR
platelet count < 100,000/mm3 without thrombocytopenic drugs
10. immunologic disorder
anti-DNA, antibody to dsDNA [native DNA] in abnormal titer, OR
anti-Sm Ab (antibody to Sm nuclear antigen), OR
positive finding of antiphospholipid antibodies based on
abnormal serum level of IgG or IgM anticardiolipin antibodies, OR
positive test for lupus anticoagulant using standard method, OR
false positive serologic test for syphilis for at least 6 months and confirmed by Treponema pallidum immobilization or fluorescent treponemal antibody absorption test
11. positive ANA of abnormal titer in absence of drugs associated with "drug-induced lupus"

SLE in Pregnancy
Women with SLE have no increase in infertility
Outcome is best for mother and child when SLE has been controlled for at least 6 months prior to pregnancy
7-33% of women with SLE have flares during pregnancy

Pregnancy Complications with SLE
Preeclampsia
Fetal Loss
Preterm Delivery
Low Birth Weight Infant
Deep Vein Thrombosis/Pulmonary Embolism

Neonatal Lupus
Occurs in about 2% of babies born to mothers w/ anti-Ro/SSA and or anti-La/SSB antibodies
Caused by passage of the antibodies from the mother’s bloodstream across the placenta to the developing baby after about 20 weeks
Signs of neonatal lupus includes red, raised rash on the scalp and around the eyes that resolves by 6-8 months (because the antibodies clear the blood stream)
SLE complications in babies: complete heart block  and learning disabilities
Risk of neonatal lupus in subsequent pregnancy is 17%..

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