- Discussion:
- affects periarticular soft tissues resulting in joint laxity with secondary dysfunction;
- minimal synovitis - articular cartilage is preserved;
-
Raynaud's phenomenon is common;
- diagnosis depends on positive FANA test along with three other criteria:
- swollen joints
- nephritis
- pericarditis
- severe rash
- Clinical Presentation:
- typically affects teenage girls;
- constitutional symptoms are common;
- malar (butterfly) rash;
-
affected systems:
- renal
- bone marrow
- central nervous system
- cardiopulmonary
- joints:
- painful, debilitating, red, hot arthritis;
- rarely leads to deformity;
- arthritis responds to
steroids;
-
lupus of the hand and wrist:
- causes ligamentous laxity affecting the MCPs;
- in contrast w/ SLE, in which phalanges are involved & knuckles are spared, erythema of dermatomyositis spares phalanges;
- Laboratory Aspects:
-
ANA is typically high ( > 1:640)
- anti–double-stranded (native) DNA antibodies
-
lupus anticoagulant
- complement;
- Treatment:
-
steroids:
-
methotrexate:
- indicated for Lupus patients with major joint and/or skin involvement in whom their is
no major organ involvement;
- soft tissue reconstructions are not effective;
- high recurrance rate
- joint fusions are preferable to restore stability and function;
-
MP arthroplasties are effective even though they sacrifice normal appearing cartilage;
Patellar tendon rupture in systemic lupus erythematosus.
The hand in systemic lupus erythematosus. G. Dray.
Hand Clinics. Vol 5. 1989. p 145-155.
The 1982 revised criteria for the classification of systemic lupus erythematosus.
Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.
