What is the evidence for the management of moderate SLE? For chronic maintenance treatment, GC should be minimized to less than 7. What is the evidence for the management of severe SLE [ 272829 ]? Mean rate ± SD: 8. LOE 5, GOR D Flares of SLE can be treated according to the severity of organ s involvement by adjusting ongoing therapies glucocorticoids, immunomodulating agents to higher doses, switching or adding new therapies.
Drugs Mentioned In This Article
What are the recommendations for the management of refractory patients? What are the recommendations for specific organ system involvement in SLE? First line treatment is HCQ. If needed, GCs low dose can be added. Cutaneous lupus erythematosus CLE First-line treatment of skin disease in SLE includes topical GCs agents in people with localized CLE including the face for up to 4 weeks in addition to systemic therapy in more wide spreads disease.
If persistent skin disease inadequate response to HCQ and topical steroidsmethotrexate, mycophenolate, and topical retenoids can be used.
Pulsed-dye laser or surgery can be used for localized, refractory lesions of CLE. LOE 3, GOR C Neuropsychiatric SLE Diffuse neuropsychiatric syndromes include aseptic meningitis, demyelinating syndrome, headache, acute confusional state, anxiety disorder, cognitive dysfunction, mood disorder, and psychosis.
Focal NP syndromes include cerebrovascular disease, Guillain—Barre syndrome, movement disorder, myelopathy, seizure disorders, autonomic neuropathy, mononeuropathy, myasthenia gravis, cranial neuropathy, plexopathy, and polyneuropathy Neuroimaging, CSF analysis, assessment of presence of APL antibodies are recommended.
Management of NPSLE depends on the underling pathogenesis whether it is an ischemic or an inflammatory pathway. Warfarin is preferred to direct oral anticoagulants in patients with thromboembolic antiphospholipid syndrome with high-risk antiphospholipid antibody.
LOE 4, GOR C Cardiac manifestation To detect cardiac abnormalities such as pericarditis, myocardial dysfunction, and valvular lesions, echocardiography is used as a sensitive and specific investigation. HCQ can be used for diffuse arthralgia.
If there is no response, discontinuation of the drug is recommended to prevent the risk of toxicity. If the lesions become hemodynamically significant, valve surgery may be needed LOE 3, GOR C Hematological disease Thrombocytopenia Thrombocytopenia may be related to active disease, APS or a complication of immunosuppressant as azathioprine.
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- Diagnosis[ edit ] Diagnosis involves interviewing the patient and performing physical exams.
Examination of the peripheral blood smear is recommended when microangiopathic hemolytic anemia MAHA or thrombotic microangiopathy TMA are suspected. Initial therapy with pulses of IV MP 1—3 days is recommended. Pain management may include stretching exercises, over the counter pain medications, prescription pain medication, or other treatments deemed appropriate for the symptoms.
Pain in Multiple Joints
Capsaicina substance found in chili peppersmay relieve joint pain from arthritis and other conditions. Capsaicin blocks the actions of substance Pwhich helps transmit pain signals, and capsaicin triggers the release of pain-blocking chemicals in the body known as endorphins.
There, she volunteered in a wildlife resort, taking care of a variety of monkeys and wild cats. One day after leaving the resort she developed spiking fevers, headache, myalgia followed by aphthous oral ulcers and a maculopapular rash of the whole body four days later. Around the same time she developed a diffuse arthralgia, which after initial improvement slowly worsened and became highly incapacitating.
Her previous medical history was unremarkable.
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She did not take regular medication. Prior to her travel, she had received complete vaccinations for yellow fever, rabies, hepatitis A and B. On physical examination tenderness and mild swelling of both ankles was noted.
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Tenderness of the elbows, shoulders and interphalangeal joints and wrists without swelling was also observed. Results of a full blood count, liver and renal function tests were normal, as were levels of electrolytes, lactate dehydrogenase, and C-reactive protein. Blood cultures remained sterile.
Blood smears for malaria were repeatedly negative. Serologic testing for cytomegalovirus, hepatitis C virus, human immunodeficiency virus, Borrelia burgdorferi, and Treponema pallidum were negative. Serology for Epstein-Barr virus and parvovirus B19 was indicative of past infection.
In addition, autoimmune serology including anti-citrullin peptide antibodies or anti-nuclear antibodies was negative. Due to her travel to the Amazon basin and prolonged course of arthralgia, MAYV infection was considered as a differential diagnosis.
Open in a separate window aGI, gastronintestinal; Temp. Go to: Results The triad of abdominal symptoms, eosinophilia, and liver enzyme impairment evoked the possibility of a helminthic infection. On further questioning, the couple recalled having eaten a smoked carp 10 days before becoming sick.
During follow up visits the patient reported persistent arthalgias of both ankles and elbows, which slowly improved over time. The patient continued to take NSAID for over 2 months and her symptoms finally resolved after 5 months.
Bilateral symmetric polyarthralgia revealing Fanconi's syndrome
MAYV infection is still rare in travellers and consultation of infectious disease specialists is instrumental in making the correct diagnosis [ 4 ]. Although palpation often can identify synovitis, it may not detect inflammation of more proximal joints in, for example, elderly patients with polymyalgia rheumatica. Fibromyalgia is suggested by the presence of polyarticular joint pain without synovitis, along with myalgias and tender points.
Hand synovitis is distinctly unusual in chronic Lyme disease. Osteoarthritis tends to spare wrists, elbows, and ankles, unless there is a history of trauma, inflammation, or a metabolic disorder such as hemochromatosis.
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Depending on the underlying cause, the pattern of arthritis may change over time. For example, the acute stage of Lyme disease may include polyarticular arthralgias, whereas the chronic phase may include oligoarthritis, primarily in the knees. Of eight variables examined in one study, 18 symmetric pain was the most potent discriminating feature for rheumatoid arthritis.