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Systemic Lupus Erythematosus

The American College of Rheumatology (ACR) classification criteria states that the presence of 4 or more of the following symptoms (in the absence of other causes for those symptoms) are indicative of a diganosis of Lupus.

1. ArthritisNonerosive Involving 2 or more peripheral joints, characterized by tenderness, swelling, or effusion
2. Malar RashFixed erythema, flat or raised, over the malar eminences, tending to spare the nasolabial folds
3. Discoid RashErythematous raised patches with adherent keratotic scaling and follicular plugging; atrophic scarring may occur in older lesions
4. PhotosensitivitySkin rash as a result of unusual reaction to sunlight, by patient history or physician observation
5. Oral UlcersOral or nasopharyngeal ulceration, usually painless, observed by physician
6. Pleuritis or Pericarditis
  1. Pleuritis – convincing history of pleuritic pain or rubbing heard by a physician or evidence of pleural effusion

  2. OR
  3. Pericarditis–documented by electrocardigram or rub or evidence of pericardial effusion
7. Renal Disorder
  1. Persistent proteinuria > 0.5 grams per day or > than 3+ if quantitation not performed

  2. OR
  3. Cellular casts – may be red cell, hemoglobin, granular, tubular, or mixed
8. Neurological Disorder
  1. Seizures–in the absence of offending drugs or known metabolic derangements; e.g., uremia, ketoacidosis, or electrolyte imbalance

  2. OR
  3. Psychosis–in the absence of offending drugs or known metabolic derangements, e.g., uremia, ketoacidosis, or electrolyte imbalance
9. Haematological
  1. Haemolytic anemia – with reticulocytosis

  2. OR
  3. Leukopenia – < 4,000/mm3 on = 2 occasions

  4. OR
  5. Thrombocytopenia–<100,000/ mm3 in the absence of offending drugs
10. ANA PositiveAn abnormal titer of antinuclear antibody by immunofluorescence or an equivalent assay at any point in time and in the absence of drugs
11. Immunological
  1. Anti-DNA: antibody to native DNA in abnormal titer

  2. OR
  3. Anti-Sm: presence of antibody to Sm nuclear antigen

  4. OR
  5. Positive finding of antiphospholipid antibodies on:
    1. an abnormal serum level of IgG or IgM anticardiolipin antibodies,

    2. OR
    3. a positive test result for lupus anticoagulant using a standard method, or

    4. OR
    5. a false-positive test result for at least 6 months confirmed by Treponema pallidum immobilization or fluorescent treponemal antibody absorption test
    NOTE: Patients who do not completely fulfil the ACR criteria may be labelled as an UCTD (Undifferentiated Connective tissue Disorder) or lupus-like disorder. These patients require the same treatment as lupus dictated by the severity of the disease.

    This information was derived from the 1997 update of the 1982 ACR classification criteria for SLE Arthritis Rheum 1997;40:1725. .

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