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From the American College of Rheumatology here is a list of symptoms and diagnostic criteria:

SYMPTOMS OF SLE
Arthralgia
Arthritis
Fever (>100*F)
Skin Rashes
Anemia
Kidney Damage
Pleurisy
Facial Rash
Photosensitivity
Alopecia (hair Loss)
Raynauds' Phenomenon
Seizures
Mouth or Nose Ulcers

ACR CRITERIA FOR DIAGNOSING SLE
Malar Rash
Discoid Rash
Photosensitivity
Oral Ulsers
Arthritis
Serositis (pleuritis or pericarditis)
Renal Disorder (persistent Proteinuria or cellular casts)
Neurological disorder (seizures or psychosis)
Hematologic disorder (anemia, Leukopenia or lymphopenia on two or more occasions, thrombocytopenia
Immunologic disorder (positive LE cell preparation, abnormal anti-DNA or ANTI-Sm values, False postive VDRL (syphilis test)
Abnormal ANA Titre

"The american College of Rheumatology (ACR) an organization of doctors and associated health professionals who specialize in arthritis and related diseases of the bones, joints and muscles, has developed and refined a set of diagnostic criteria...if at least 4 of the 11 criteria develop at one time or individually over any period of observation, then the patient is likely to have SLE however, a diagnosis of SLE can be made in a patient having fewer than four of these symptoms." [B]

ADDITIONAL CRITERIA FROM LONDON:
ST THOMAS HOSPITAL CRITERIA FOR DIAGNOSING SLE

1. Teenage "growing pains"

Growing pains in the UK, is a label widely used for joint pains in teenagers and seems to cover a spectrum of rheumatology from arthritis through to lupus.

2. Teenage migraine

headache, cluster headache and migraine can be encountered and a strong history of teenage migraine may be of Lupus significance, either at the time or subsequently.

3. Teenage "glandular fever"

Prolonged teenage glandular fever is a label which crops up time and time again in lupus patients and prolonged periods off school in many SLE patients is a recurrent theme.

4. Severe reaction to insect bites

This is a feature of so many lupus patients. Not only are they susceptible to insect bites but often reactions are severe and prolonged - the skin is a major organ affected by Lupus.

5. Recurrent miscarriages

Lupus itself seems not to be a cause of recurrent miscarriage but where the antiphospholipid syndrome (APS) is present, recurrent spontaneous fetal loss can be significant.

6. Premenstrual tension

Although difficult to quantify, it is believed that significant pre-menstrual disease flare is sufficiently prominent in lupus to be included in this list. All rheumatic diseases are clinically influenced by the menstrual cycle.

7. Septrin (and sulphonamide allergy)

Adverse reactions to these drugs is quite common in Lupus and the clinical onset of the disease may have coincided with the use of eg Septrin.

8. Agoraphobia

Agoraphobia/claustrophobia are often present at a time when lupus disease is active. A history of these conditions (including panic attacks), can be protracted, lasting for months or even years. In many cases the history is not volunteered or the episodes are in the interim considered unrelated to lupus.

9. Finger Flexor Tendonitis

Arthralgia and tenosynovitis are common features in lupus and although not specific, the finding of mild to moderate ten-finger flexor synovitis is a useful pointer in the presence of other lupus features. It si subtly yet significantly different in pattern from other arthritic diseases.

10. Family history of autoimmune disease

As the genetics and statistics of the various autoimmune diseases become better defined, the strength of a particular family history will become more precise. the family history is important, as lupus is genetically determined (although not 100% concordant as with, for example, genetic diseases which are always passed on eg haemophilia).

11. Dry Shirmer's Test

A "bone dry" Shirmer's Test (levels of eye moisture) points towards one of the autoimmune diseases and in the patient with vague or nonspecific symptoms is worth its weight in gold.

12. Borderline C4

Genetic complement deficiencies have been known to be associated with Lupus for over three decades and in the diagnostically difficult patient, especially where a family history is present, borderline C4 levels can be significant indicators.

13. Normal CRP with raised ESR

An important diagnostic aid. A very low CRP in an otherwise inflammatory situation is strongly supportive of Lupus or primary Sjögren's Syndrome.

14. Lymphopenia

In the patient with non-specific complaints and unremarkable blood tests, a borderline or low lymph count can be overlooked. It can be common in lupus and is certainly worth inclusion among minor criteria.

Hope this helps.





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