1. The Presentation of some cases with “Systemic Lupus Erythematosus”
Iraj Salehi-Abari
The Presentation of some cases with “Systemic Lupus Erythematosus”
Iraj Salehi-Abari MD.,
Internist
Rheumatologist
SLE

2. In the name of God the merciful and compassionate

3. Iraj Salehi-Abari
Case I:
A 30 year-old woman one month after coming back from seaside has:
Malar rash
Frank non-scaring alopecia
Oral superficial painless ulcer
Normal Lab. Data y
SLE

4. Case II: A 40 year-old woman with: Palpable purpura in legs
Iraj Salehi-Abari
Case II:
A 40 year-old woman with:
Palpable purpura in legs
WBC: 2500/mm3, L: 20%, Hb: 10, Ret: 12%, Plt: 110,000
FANA; 1/640 (up to 1/40), rim pattern
Skin Bx: Leukocytoclastic vasculitis y
SLE

5. Case III: A 27 year-old woman hospitalized with:
Iraj Salehi-Abari
Case III:
A 27 year-old woman hospitalized with:
Generalized pitting edema
Frank alopecia
Proteinuria: 550 mg/24 hr, urine casts
Positive high titer Anti-dsDNA
Disagreement with renal Bx. y
SLE

6. Case IV: A 39 year-old woman with: Malar rash, Good general condition
Iraj Salehi-Abari
Case IV:
A 39 year-old woman with:
Malar rash, Good general condition
History of two episodes of convulsion
Bilateral pleural effusion
Hb: 11, MCV: 80, Ret: 1.3%, ESR: 80
No other abnormal Lab. data y
SLE

7. Case V: A 20 year-old woman with: Frank alopecia
Iraj Salehi-Abari
Case V:
A 20 year-old woman with:
Frank alopecia
Polyarthralgia/myalgia
Positive FH of SLE in her mother
High titer ANA and Anti-dsDNA positivity y
SLE

8. Diagnosis: History & Physical examination Laboratory tests: CXR-PA y
Iraj Salehi-Abari
Diagnosis:
History & Physical examination
Laboratory tests:
CBC, serum Cr, U/A, ESR, CRP
FANA
Anti-dsDNA, Anti-Sm, VDRL, LE, LA, aCL, Anti-B2GPI, C3/C4/CH50
CXR-PA y
SLE

9. Diagnosis: Using a questionnaire: “SLE Questionnaire”
Iraj Salehi-Abari
Diagnosis:
Using a questionnaire: “SLE Questionnaire”
Diagnosis of SLE can be established by “clinical judgment “of an expert Rheumatologist
There are two Classification criteria:
ACR , SLICC
The only Diagnostic criteria:
2015 ACR/SLICC revised Criteria for Diagnosis of SLE y
SLE

10. Diagnosis: 1997 “ACR” classification criteria for SLE
Iraj Salehi-Abari
Diagnosis:
1997 “ACR” classification criteria for SLE
2012 “SLICC” classification criteria for SLE
Above classification criteria have been developed for SLE as a means of categorizing patients for study purposes y
SLE

11. “SLE Questionnaire”: Arthritis > 3 months Raynaud phenomenon
Iraj Salehi-Abari
“SLE Questionnaire”:
Arthritis > 3 months
Raynaud phenomenon
Oral ulcer > 2 weeks
Cytopenia
Rash on cheeks > 1 month
Photosensitivity
Pleurisy > a few days
Protein in urine
Rapid loss of hair
Convulsion
[with > 3 positive answers possibility of SLE] y
SLE

12. “ACR” Classification criteria:
Iraj Salehi-Abari
“ACR” Classification criteria:
Malar rash [with at least 4 criteria out of 11 SLE]
DLE
Photosensitivity
Oral Ulcer
Arthritis
Psychosis/Seizure
Pleurisy/pericarditis
Renal
Hematologic
Positive ANA
Positive anti-dsDNA or Anti-Sm or aPL y
SLE

13. “SLICC” Classification criteria:
Iraj Salehi-Abari
“SLICC” Classification criteria:
Clinical criteria:
ACLE : Malar rash/photosensitivity/SCLE
CCLE: DLE
Nonscarring alopecia
Oral/nasal ulcer
Joint disease
Pleurisy/pericarditis
Renal
Neurologic
Hemolytic anemia
Leukopenia/lymphopenia
Thrombocytopenia y
SLE

14. “SLICC” Classification criteria:
Iraj Salehi-Abari
“SLICC” Classification criteria:
Immunologic criteria:
ANA
Anti-dsDNA
Anti-Sm
aPL antibodies
Low complement
Direct Coomb’s test
11 clinical + 6 immunologic = 17 criteria y
SLE

15. “SLICC” Classification criteria:
Iraj Salehi-Abari
“SLICC” Classification criteria:
With 4 criteria out of 17 including at least one criteria from each group: definite SLE
Lupus nephritis in biopsy along with positive ANA or anti-dsDNA : definite SLE y
SLE

16. Iraj Salehi-Abari
Case I:
A 30 year-old woman one month after coming back from seaside has:
Malar rash
Frank non-scaring alopecia
Oral superficial painless ulcer
Normal Lab. Data
ACR: No SLE
SLICC: No SLE
But upon clinical judgment: SLE
2015 ACR/SLICC revised criteria: SLE y
SLE

17. Case II: A 40 year-old woman with: Palpable purpura in legs
Iraj Salehi-Abari
Case II:
A 40 year-old woman with:
Palpable purpura in legs
WBC: 2500/mm3, L: 20%, Hb: 10, Ret: 12%, Plt: 110,000
FANA; 1/640 (up to 1/40), rim pattern
Skin Bx: Leukocytoclastic vasculitis
ACR: No SLE
SLICC: No SLE
But upon clinical judgment: SLE
2015 ACR/SLICC revised criteria: SLE y
SLE

18. Case III: A 27 year-old woman hospitalized with:
Iraj Salehi-Abari
Case III:
A 27 year-old woman hospitalized with:
Generalized pitting edema
Frank alopecia
Proteinuria: 550 mg/24 hr, urine casts
Positive high titer Anti-dsDNA
Disagreement with renal Bx.
ACR: No SLE
SLICC: No SLE
But upon clinical judgment: SLE
2015 ACR/SLICC revised criteria: SLE y
SLE

19. Case IV: A 39 year-old woman with: Malar rash, Good general condition
Iraj Salehi-Abari
Case IV:
A 39 year-old woman with:
Malar rash, Good general condition
History of two episodes of convulsion
Bilateral pleural effusion
Hb: 11, MCV: 80, Ret: 1.3%, ESR: 80
No other abnormal Lab. data
ACR: No SLE
SLICC: No SLE
But upon clinical judgment: SLE
2015 ACR/SLICC revised criteria: SLE y
SLE

20. Case V: A 20 year-old woman with: Frank alopecia Arthralgia/myalgia
Iraj Salehi-Abari
Case V:
A 20 year-old woman with:
Frank alopecia
Arthralgia/myalgia
Positive FH of SLE in her mother
High titer ANA and Anti-dsDNA positivity
ACR: No SLE
SLICC: No SLE
But upon clinical judgment: SLE
2015 ACR/SLICC revised criteria: SLE y
SLE

21. Iraj Salehi-Abari
Diagnosis:
Right now in the absence of existing Diagnostic criteria for SLE, the general approach to the diagnosis of SLE is:
Step I: fulfilling the 1997 ACR classification criteria
Step II: fulfilling the 2012 SLICC classification criteria
Step III: There are significant percent of the patients who do not fulfill the above classification criteria
So, we need an accurate diagnostic criteria for early diagnosis and right now the main way of diagnosis is “clinical judgment” y
SLE