Discuss Lupus diagnostic criteria and clinical manifestations
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Discuss how research into understanding the mechanisms of SLE is advancing treatment for lupus

Lupus Diagnostic Criteria
1. Malar Rash: Fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds
2. Discoid rash: Erythematous raised patches with adherent keratotic scaling and follicular plugging; atrophic scarring may occur in older lesions
3. Photosensitivity: Skin rash as a result of unusual reaction to sunlight, by patient history or physician observation
4. Oral ulcers: Oral or nasopharyngeal ulceration, usually painless, observed by physician
5. Nonerosive Arthritis: Involving 2 or more peripheral joints, characterized by tenderness, swelling, or effusion
6. Pleuritis or Pericarditis: a) Pleuritis--convincing history of pleuritic pain or rubbing heard by a physician or evidence of pleural effusion OR b) Pericarditis--documented by electrocardigram or rub or evidence of pericardial effusion
7. Renal Disorder: a) Persistent proteinuria > 0.5 grams per day or > than 3+ if quantitation not performed OR b) Cellular casts--may be red cell, hemoglobin, granular, tubular, or mixed
8. Neurologic Disorder: a) Seizures--in the absence of offending drugs or known metabolic derangements; e.g., uremia, ketoacidosis, or electrolyte imbalance OR b) Psychosis--in the absence of offending drugs or known metabolic derangements, e.g., uremia, ketoacidosis, or electrolyte imbalance
9. Hematologic Disorder: a) Hemolytic anemia--with reticulocytosis OR b) Leukopenia--< 4,000/mm3 on ≥ 2 occasions OR c) Lymphopenia--< 1,500/ mm3 on ≥ 2 occasions OR d) Thrombocytopenia--<100,000/ mm3 in the absence of offending drugs 10. Immunologic Disorder: a) Anti-DNA: antibody to native DNA in abnormal titer OR b) Anti-Sm: presence of antibody to Sm nuclear antigen OR c) Positive finding of antiphospholipid antibodies on: an abnormal serum level of IgG or IgM anticardiolipin antibodies, a positive test result for lupus anticoagulant using a standard method, or a false-positive test result for at least 6 months confirmed by Treponema pallidum immobilization or fluorescent treponemal antibody absorption test 11. Positive Antinuclear Antibody: An abnormal titer of antinuclear antibody by immunofluorescence or an equivalent assay at any point in time and in the absence of drugs Arthritis Painful joints are #1 symptom in 76-100% of patients With or without signs of inflammation, mild effusions if any Usually involve hands, wrists, knees Can be asymmetric Generalized myalgias particularly deltoids and quads <15% with elevations in CPK Nephritis Very closely linked with prognosis 5- and 10-year survival rates are documented as high as 85% and 73%, respectively (used to be about 0% before immunosuppressants) Diagnosed by presence of proteinuria (>500mg/24 hours)
Watch for symptoms of edema, puffy eyes, frequent urination.
Biopsy helpful to determine whether aggressive treatment is required

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