SLE – Systemic Lupus Erythemetosus Diagnostic Criteria

SLE – Systemic Lupus Erythemetosus From Where SLE name derived?

Lupus means wolf, named because the erosive nature of the condition that looks like the damage caused by hungry wolf. SLE is more in Female : Male = 9:1, age 2nd and 3rd decade. Sex ratio is equal in children and elderly.

Fig: Butterfly Rash

If you suspect a patient that she is suffering from SLE; what other features do you want to see?

1)      Skin rash in the other part of the body

Fig: Skin Rash

2)      Mouth Ulcer (Sharply defined white patch with red margin)

Fig: Mouth Ulcer in SLE in hard palate is very characteristic

3)      Alopecia (Scarring)

Fig: Alopecia Scarring

4)      Arthropathy or arthritis

5)      History of

1. Whether the rash is aggravated on exposure to sunlight
2. Drugs ( Some drugs cause SLE) and Oral Pill
3. Repeated abortion in female
4. Convulsion, Depression, unconsciousness or paralysis or paresis
5. Raynaud’s phenomenon (present in 20% case)
6. History of Deep Vein Thrombosis or thromboembolism
7. Family History of SLE

Diagnostic Criteria of SLE

1) Malar Rash

Fig: Malar Rash In SLE

2) Discoid Rash

Fig: Discoid Rash in SLE

3) Photosensitivity

4) Oral ulcer

5) Arthritis (nonerosive arthritis involving two or more peripheral joints with tenderness, swelling or effusion)

6) Serosities

1. Pleurisity or Pleural effusion
2. Pericardities

7)      Renal involvement

1. Persistent Proteinurea > 0.5gm per day
2. Greater than 3+ (If total urinary protein is not performed)
3. Cellular cast (red cell, granular, tubular)

8)      Neurologic disorder – seizure, psychosis in the absence of offending drug or metabolic dearrangement (uremia, ketoacidosis, electrolytes imbalance)

9)      Hematological Disorder

1. Hemolytic Anemia
2. Leucopenia (< 4000/cmm in 2 or more occasion)
3. Lymphopenia (<1000/cmm in 2 or more occasion)
4. Throbocytopenia (< 100000/cmm in the absence of offending drug)

10)   Immunological Disorder

1. Anti DNA antibody in abnormal titre
2. Anti Sm antibody (Presence of antibody to Sm nuclear antigen) or
3. Positive Anti Phospolipid antibody
4. False positive serological tests for syphilis (positive for at least 6 months and confirmed by treponema pallidum immobilization or flurescent trepanomal antibody absorption test)

11)   ANA Positive (in the absence of drugs causing lupus syndrome)

Fig: SLE patient

NB: Presence of 4 or more criteria at a time or sequential appearance is diagnostic. Positive Anti ds DNA and ani-Sm(Smith) antibody is diagnostic of SLE