SLE

STATION 5
BY DR.SADEK AL-ROKH
SENARIO

Hand pain , small joints pain of both hands

Skin rash

HISTORY

Onset

Course

Duration

Progression

Ask the patient about Nature of the pain ( burning , dull , electric like, pins
and needles ) to differentiate between polyarthritis , Raynauds and carpal tunnel

Site of pain :Unilateral or bilateral (symmetry) which joint involved

(knuckles near joints or far joints)?

Worsening factors ie movement , cold weather

Improving factors .i.e. rest , any drugs

Timing more at morning or night .. carpal tunnel more at sleep time .

Any other joint involved? Back pain?

Grade of the pain from 0 -10.

Morning stiffness? For how long?

Systemic review:
any color changes when exposed to cold weather (Raynauds phenomenon)
skin rash ,analysis of the rash, does the rash worsened by exposure to sun
(photosensetivity)?
loose motions (enteropathic arthritis)
burning micturition (reactive arthritis)
eye symptoms i.e. pain , redness

Ask about other criteria of SLE

Mouth sores
Falling of hair ( discoid lupus)
Joint pain ( arthritis)
Chest pain,racing of heart beats ,SOB on exertion , on lying down , awaken
him from sleeping , leg swelling (2nd pulmonary HPN) , ( pleuritis ,
pericarditis , myocarditis , libman-sacs endocarditis)
Bombs or lumps ( lymphadenopathy )
Any pallor or fatigue ( anemia)
Any change in urine amount , color , frothy urine , eye puffiness ( lupus
nephritis )?
Seizures , weakness , pins and needles (lupus cerebritis)
Symptoms of Anti phospholipid syndrome: hx of abortion , blood clot , FH
of blood clot ?

For Mixed connective tissue disease

Hand deformity , SOB , any finger color changes in cold weather (
Raynauds) RA
SOB, cough , Difficulty of swallowing , (Raynauds) SS
Proximal myopathy ( difficulty of combing hair or getting up from a
chair ) , muscle pain Dermatomyositis
Dry mouth , gritty eye sensation Sjogren

Social history

Job and how much impact job and usual daily activity?If do say: I am
sorry I will refer u to a social worker to solve this problem for you ( very
important)

With whom he is living?

Financial support

Smoking + alcohol

M .H : DM , HPN , IHD
F.H: of similar condition , DM , HPN
Drug history: What is your drug list?

Examination
HAND:
o LOOK : for joint swelling, deformity scars , pigmentation

o FEEL : for warmness by comparing by dorsum of the same hand

between hand joints and forearm and soreness by delicate
compression of the joints between your fingers .

o MOVE (Functional status) : prayer sign , reversed prayer sign

, fest compression , picking up coins , buttoning and unbuttoning .
o Examine for proximal myopathy by both arms power (
dermatomyositis , steroid therapy )

Head:
Cushingoid features, butterfly rash , plethoric ,round face (steroid
therapy complication)
The oral cavity for any mouth sores.
Examine the SCALP : for hair falling or scarring
BODY:for truncal obesity , intrascapular, supra clavicular fat bad , stia alba and
rubra ( complications of steroids )
CVS : jvp , murmurs for libman-sacs endocarditis , bibasal lung auscultation .
LL : edema ( as a complication of cardiac or renal involvement)

N.B : dont forget in jaccod arthropathy in SLE the is hand finger deformity
looks like RA in which the deformity is non erosive , can be corrected and no X
ray changes like RA

Concerns
What could be the cause doctor ?
Most properly you have a disease called SLE , due to disturbance in your
defensive system , attacking many systems in your body .

We have to do for you further blood tests and imaging to confirm our
diagnosis , then we will refer you to a multidisciplinary team involving
rheumatologist , social worker , psychiatrist , to give you the plan of
management .
N.B If there is symptoms or signs of Lupus nephritis , tell the patient that a
snip from the kidney may be needed under aseptic condition and anesthesia
to make staging for the disease .

Is it curable doctor ?
Im sorry its not curable , but it can be controlled by restrict and
compliance on medications and fellow up .