Systemic Lupus Erythematosus Diagnosis
[comment memo="Summary: Clinical decision tool for Systemic Lupus Erythematosus. This does actually suggest or refute a diagnosis of SLE if you get through all 3 steps and hit *Submit*]
Step 1: Organ Systems Affected
[select name="Q1" value="NO=0|YES=.1"] <-- Constitutional: Fatigue, fever (in the absence of infection), weight loss
[select name="Q2" value="NO=0|YES=.1"] <-- Skin: Butterfly rash, photosensitivity rash, mucous membrane lesion, alopecia, Raynaud’s phenomenon, purpura, urticaria, vasculitis
[select name="Q3" value="NO=0|YES=.1"] <-- Musculoskeletal: Arthritis, arthralgia, myositis
[select name="Q4" value="NO=0|YES=.1"] <-- Renal: Hematuria, proteinuria, cellular casts, nephrotic syndrome
[select name="Q5" value="NO=0|YES=.1"] <-- Hematologic: Anemia, thrombocytopenia, leukopenia
[select name="Q6" value="NO=0|YES=.1"] <-- Reticuloendothelial: Lymphadenopathy, splenomegaly, hepatomegaly
[select name="Q7" value="NO=0|YES=.1"] <-- Neuropsychiatric: Psychosis, seizures, organic brain syndrome, transverse myelitis, cranial neuropathies, peripheral neuropathies
[select name="Q8" value="NO=0|YES=.1"] <-- Gastrointestinal: Nausea, vomiting, abdominal pain
[select name="Q9" value="NO=0|YES=.1"] <-- Cardiac: Pericarditis, endocarditis, myocarditis
[select name="Q10" value="NO=0|YES=.1"] <-- Pulmonary: Pleurisy, pulmonary hypertension, pulmonary parenchymal disease
Step 2: If 2 or more systems in Step 1 are affected then get ANA titer.
[select name="Q11" value="Greater than/equal to 1:40=10|Less than 1:40=0"] <-- ANA titer
Step 3: If the titer is greater than 1:40 then get the labs (complete blood count; urinalysis; serum creatine level; and antiphospholipid, anti- dsDNA, and anti-Sm antibodies.) The diagnosis of systemic lupus erythematosus requires the presence of four or more of the following 11 criteria, serially or simultaneously, during any period of observation.
[select name="Q12" value="NO=0|YES=100"] <-- Malar rash: fixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds
[select name="Q13" value="NO=0|YES=100"] <-- Discoid rash: erythematous, raised patches with adherent keratotic scaling and follicular plugging; possibly atrophic scarring in older lesions
[select name="Q14" value="NO=0|YES=100"] <-- Photosensitivity: skin rash as a result of unusual reaction to sunlight, as determined by patient history or physician observation
[select name="Q15" value="NO=0|YES=100"] <-- Oral ulcers: oral or nasopharyngeal ulceration, usually painless, observed by physician
[select name="Q16" value="NO=0|YES=100"] <-- Arthritis: nonerosive arthritis involving two or more peripheral joints, characterized by swelling, tenderness, or effusion
[select name="Q17" value="NO=0|YES=100"] <-- Serositis: pleuritis, by convincing history of pleuritic pain, rub heard by physician, or evidence of pleural effusion; or pericarditis documented by electrocardiography, rub heard by physician, or evidence of pericardial effusion
[select name="Q18" value="NO=0|YES=100"] <-- Renal disorder: persistent proteinuria, > 500 mg per 24 hours (0.5 g per day) or > 3+ if quantitation is not performed; or cellular casts (may be red blood cell, hemoglobin, granular, tubular, or mixed cellular casts)
[select name="Q19" value="NO=0|YES=100"] <-- Neurologic disorder: seizures or psychosis occurring in the absence of offending drugs or known metabolic derangement (e.g., uremia, ketoacidosis, electrolyte imbalance)
[select name="Q20" value="NO=0|YES=100"] <-- Hematologic disorder: hemolytic anemia with reticulocytosis; or leukopenia, < 4,000/mm3 on two or more occasions; or lymphopenia, < 1,500/mm3 on two or more occasions; or thrombocytopenia, < 100,000/mm3 in the absence of offending drugs
[select name="Q21" value="NO=0|YES=100"] <-- Immunologic disorder: antibody to double-stranded DNA antigen (anti-dsDNA) in abnormal titer; or presence of antibody to Sm nuclear antigen (anti-Sm); or positive finding of antiphospholipid antibody based 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 serologic test for syphilis that is known to be positive for at least 6 months and is confirmed by negative [select name="Q22" value="NO=0|YES=100"] <-- Treponema pallidum immobilization or fluorescent treponemal antibody absorption test
[select name="Q23" value="NO=0|YES=100"] <-- Antinuclear antibodies: an abnormal antinuclear antibody titer by immunofluorescence or equivalent assay at any time and in the absence of drugs known to be associated with drug-induced lupus
Interpretation --> [calc value="score=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9)+(Q10)+(Q11)+(Q12)+(Q13)+(Q14)+(Q15)+(Q16)+(Q17)+(Q18)+(Q19)+(Q20)+(Q21)+(Q22)+(Q23);score>400.1?'SLE':score>10.1?'No SLE or Incomplete SLE':score>.1?'Strong argument against SLE, find other explanation or consult rheumatology':'Very unlikely'" memo="interpretation"]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"]
[link url="//www.aafp.org/afp/2003/1201/p2179.html" memo="#1"] Am Fam Physician 2003;68:2179-86.
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