These days medical students are just flooded with a huge amount of information – different description of diseases, fresher and fresher publications – all available online. It is really difficult to pick the clinically relevant data, especially when you do not have those years of practice behind your back. In our blog series You will find short and straightforward lists of clinical signs and symptoms which are the most typical and pathognomonic in certain diseases.
Since House MD., we all know, that it is NOT lupus! Jokes aside, the series referred to a fact: the initial diagnosis of SLE depends on the manifestation of the disease, what “shape” it takes and the exclusion of alternative diagnoses. The clinical heterogeneity of the disease is always a diagnostic challenge for the physicians. Here we have collected those signs that will be the patient’s main complaints when they turn to us for help.
1. Arthritis, arthralgia
Why? These symptoms occur very often in patients with SLE, and they can also be one of the earliest signs of the disease. They are characterized as polyarticular, symmetrical or migratory joint pain or swelling.
2. Skin and mucous membrane lesions
Why? The “butterfly rash” on the face is considered to be the most common form, but photosensitivity-related lesions, oral or nasal ulcers and alopecia also appear frequently in patients with SLE.
3. Raynaud’s phenomenon
Why? Raynaud phenomenon is transient, reversible ischemia appearing in the acral body parts, which are the most susceptible to cold injury. The phenomenon consists of 3 phases: vasoconstriction, cyanosis and rapid blood flow manifesting in white, bluish and then red color. It is the most common form of the several vascular diseases which can occur in SLE.
4. Neuropsychiatric involvement
Why? We can find different kinds of neurologic and psychiatric manifestations in SLE, including cognitive dysfunction, organic brain syndromes, delirium, psychosis, seizures, headache, and/or peripheral neuropathies.
5. Lower extremity edema
Why? It can be the indirect sign of the most dangerous complication of active disease: lupus nephritis. In this case, the antibodies form immune deposits in the mesangium and subendothelial space along the glomerular basal membrane. The deposition of these immune complexes stand behind most of the symptoms.
6. Dyspnea, chest pain
Why? These symptoms may indicate the presence of serositis - a common manifestation - in the form of pleuritis or pericarditis. Pleuritis can be present with or without effusion. ECG can detect pericarditis: widespread concave ST elevation and PR depression throughout most of the leads except aVR.
Why? Lymph node enlargement commonly occurs in association with active SLE, and usually involves the cervical, axillary and inguinal regions. The risks of both infections and lymphoproliferative disorders are more common in SLE due to immune deficits so both can stand behind the lymphadenopathy in SLE patients.
After learning the basics, test your knowledge in practice by solving cases in InSimu Patient app! You can download it for iOS or Android.