Systemic Lupus Erythematosus (SLE) and its Diagnosis

Systemic lupus erythematosus
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Introduction
Systemic lupus erythematosus (SLE) or lupus, is classified as an autoimmune disease due to the production of heterogenous group of aberrant antibodies that attacks the body's immune system (Cozzani, Drosera, Gasparini, and Parodi, 2014). Additionally, there were more than a hundred antibodies that have been described that attacks the immune system of SLE patients; especially, anti-nuclear antibodies (ANA) that is characterized by different nuclear antigen including the single strand (ss) and double strand(ds) DNA (Cozzani et al., 2014). The clinical symptoms of SLE may not be observable from the onset of the disease since these symptoms often develop on different stages of SLE (Kuhn et al., 2015). The most observed non-specific symptom of SLE during its early stages are high fever, fatigue, and joint pains; particularly, joint swelling with the appearance of a "butterfly rash" can be thought of an early symptom of SLE specially for women during their “child bearing age” (Kuhn et al., 2015).
Figure 1. Butterfly rash. Observable on lupus patients.
The classification criteria that needs to be fulfilled for the diagnosis includes a clinical criterion and an immunological criterion. The clinical criteria usually check mucocutaneous manifestations without analyzing the aberrant antibodies while the immunological criteria check for the presence of ANA or anti-dsDNA antibodies to confirm the SLE diagnosis (Kuhn et al., 2015). Although the disease is known by medical professional for several decades, there is still a need to further enhance the pathogenic, diagnostic, and prognostic understanding about the disease since it is still prevalent today (Cozzani et al., 2014). This paper focuses on the clinical criteria and immunological criteria since both are needed to successfully diagnose a patient with lupus.
Systemic lupus erythematosus Clinical Criteria
The physicians usually employ differential diagnosis during the early stages of the disease since the symptoms may vary from different people, where symptoms may also come and go, and depending of the body part affected can indicate if the disease is mild, moderate, or severe (Cojocaru, Cojocaru, Silosi, and Vrabie, 2011). SLE was initially thought of as a dermatologic condition due to manifestations of rashes and skin lesions (Cojucaru et al., 2011). The clinical criteria observe the cutaneous manifestations since about 75% of SLE patients develop skin lesions throughout the course of the disease, and other constitutional manifestation like vascular, gastrointestinal, pulmonary and musculoskeletal parameters as clues to potentially diagnose lupus (Kuhn et al., 2015).
Table 1. Clinical criteria as classified by the Systemic Lupus International Collaborating Clinics (SLICC) (Kuhn et al., 2015)
Clinical Criteria

Acute cutaneous lupus erythematosus

Chronic cutaneous lupus erythematosus

Oral ulcers

Non-scarring alopecia

Synovitis (≥ 2 joints) or tenderness on palpation (≥ 2 joints) and morning stiffness (≥ 30 min)

Serositis (pleurisy or pericardial pain for more than 1 day)

Renal involvem...