ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Systemic Lupus Erythematosus: Clinical Manifestations And Laboratory Investigations Prior To Its Diagnosis

Updated on February 13, 2014

Lupus Picture

Source

A General Overview

Systemic Lupus Erythematosus manifests on the kidney, respiratory system, the heart, the central nervous system, Muscles, the eyes and the blood. This is the continuation of the previous hub which also elaborates on its effects on the skin and joints.

Cardiovascular System:This system is affected in 25- 40% of cases. Cardiac lesiongs include dry pericarditis, pericardial effusion, myocarditis with cardiac failure and valvulitis involving the mitral valve. Libmansack’s endocarditis is a non-bacterial verrucous endocarditis affecting the mitral valve which is occasionally seen. It results in mitral incompetence. Vasculitis leads to Raynaud’s phenomenon, necrotic ulcers of the finger pulp and chronic ulcers.

Respiratory system: This system is affected in 50% of cases. Common lesions are dry pleurisy, pleural effusion, fibrosing alveolitis and lupus pneumonitis.

Kidney: This organ is affected in about 60% of cases. Renal involvement used to be the most important lesion deciding the prognosis. Renal involvement may remain asymptomatic with only proteinuria for long intervals or may manifest as hematuria, acute nephritic syndrome or renal failure. The histological pattern is that of focal glomerulonephritis, diffuse glomerulonephritis or membraneous glomerulonephritis. The wire loop lesions which are produced by thickening of the glomerular walls are characteristic on histology. Treatment instituted early in the disease helps in averting renal involvement.

Central nervous system: This is affected in 50% of the cases. Psychosis, convulsions, rarely peripheral neuropathy, myelopathy, cranial nerve paralysis, chorea and cerebella ataxia constitute the neurological manifestations.

Muscles: Myalgia and rarely polymyositis with wasting and weakness of proximal muscles are seen.

Hematology: Most of the cases show normocytic normochromic anemia. Other abnormalities include Coomb’s positive autoimmune hemolytic anemia, leucopenia and thrombocytopenia. Lupus erythematosus (LE) cells are demonstrable by suitable techniques. These are polymorphonuclear material under the influence of antibodies. Their number increases with the activity of the disease. The liver is enlarged in 60%, spleen in 60% and lymph nodes in 25% of cases. Abdominal emergencies may be produced by the development of acute peritonitis, perisplenitis, or pancreatitis.

Eyes: These may be affected in a few cases. Lesions include dryness of the conjunctiva and retinal abnormalities such as hemorrhage and exudates known as cytoid bodies.

SLE

This 42-year-old woman with systemic lupus erythematosus developed digital infarcts during a flare of disease activity. She had a positive antinuclear antibody titer of 1:1280 on Hep-2 cells by immunofluorescent antibody.
This 42-year-old woman with systemic lupus erythematosus developed digital infarcts during a flare of disease activity. She had a positive antinuclear antibody titer of 1:1280 on Hep-2 cells by immunofluorescent antibody.

Laboratory Investigations

SLE gives rise to an array of abnormalities, some being specific and the others nonspecific. The nonspecific features include, markedly elevated ESR (above 100 mm/1st hour), moderate anemia, leucopenia, proteinuria. The specific tests depend upon the immunological abnormalities and they are indicated below.

Serological abnormalities in SLE: The Antibuclear antibodies (ANA): They occur in over 99% of cases. These are composed of antibodies against DNA single strand, DNA double stand, RNA and several other nuclear components. These antibodies by themselves are not harmful, but they combine with antigens at different sites to form immune complexes and set up inflammatory responses. Though, the ANA are not specific for SLE, presence of three or more components is almost diagnostic of this disease. The titire is high during exacerbation and low during remission. Low levels of ANA occur in rheumatoid arthritis (20%), Sjogren’s syndrome 60%), scleroderma (40%) dermatomyositis (30%) and drug reactions in a variable number.

© 2014 Funom Theophilus Makama

Comments

    0 of 8192 characters used
    Post Comment

    No comments yet.

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://hubpages.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)