Internal

Medicine
Rheumatology
 Salient features
Patient: 24 y/o, F

CC: Generalized weakness

HPI:
● 1 month prior-
○ Patient noted progressive generalized
weakness associated with joint pain &
occasional low grade fever
○ No consult done, self-medicated with ● Physical Exam:
antipyretics which gave relief ○ BP: 100/70
● 3 days prior to consult- ○ HR: 110
○ Noted clumps of hair on the bathroom sink ○ RR: 26
○ TEMP: 37.8
○ O2 sat 99% at room air
○ BMI 22
○ Butterfly rash
○ Mouth sores
 Pertinent positives and negatives
● S/SX
○ (+) Joint pain ● S/SX
○ (+) Low grade fever ○ (-) chest pain
○ (+) Generalised weakness ○ (-) LBM
○ (+) Hair loss ● PHYSICAL EXAMINATION
○ (+) cough ○ Abdomen: NABS
○ (+) shortness of breathing
○ (+) palpitations
● PHYSICAL EXAMINATION
○ Skin rash (butterfly rash)
○ Mouth sores (as seen from image)
○ Chest: (+) crackles on right lower lung fields
○ Cardio: tachycardic, (+) S3 gallop
○ Extremities: PFE, (+) bipedal edema
DIFFERENTIAL DIAGNOSES

CONDITIONS RULE IN RULE OUT

Weakness, joint pain, (+)

No specific joint involvement,
RHEUMATOID ARTHRITIS PFE (proximal muscle
Pulmonary findings not seen.
weakness)

Joint pain, systemic

SJOGREN’S DISEASE No dry eyes/dry mouth
symptoms

(-) Lymphadenopathy,
EPSTEIN BARR INFECTION Weakness, Fever
hepatosplenomegaly

Absence of erythema
Skin Rash, joint pain, fever
LYME DISEASE migrans, tick exposure,
weakness
pulmonary findings
DISEASE OVERVIEW
● Definition: Autoimmune disease causing
damage to organs and cells mediated by
tissue-binding autoantibodies and immune
complexes.
● Onset: Autoantibodies often present for years
before clinical symptoms appear.
● Demographics:
○ 90% of patients are women of
child-bearing years.
○ Affects people of all genders, ages, and
ethnic groups.
○ Prevalence in the United States: 20–150
per 100,000 women, varying by race and
gender.
○ Highest prevalence in African-American
and Afro-Caribbean women.
○ Lowest prevalence in white men.
SIGNS AND SYMPTOMS
Pathophysiology
 DIAGNOSTIC TESTS
STANDARD DIAGNOSTIC TESTS
● CBC: screen for Leukopenia, lymphopenia, anemia, thrombocytopenia.
● Serum Creatinine
● Urinalysis with microscopy

OTHER DIAGNOSTIC TESTS -

● ESR or CRP (Elevated in SLE)
● Complement levels (C3 and C4 depressed in px. with SLE as a result of con
● Liver function tests (mildly elevated in acute SLE or in response to therapies such as
azathioprine or nonsteroidal anti-inflammatory drugs (NSAIDS).
● Creatine kinase assay
● Spot protein/spot creatinine ratio ( used to quantify proteinuria).
TREATMENT
—> Nonsteroidal anti-inflammatory drugs (NSAIDs) :
to alleviate joint pain, fever, and inflammation.

—>Antimalarial drugs (e.g., hydroxychloroquine): help manage skin rashes, joint pain, and fatigue in
patients with SLE.

—>Immunosuppressive medications: methotrexate, azathioprine or cyclophosphamide used to suppress

the immune system and reduce disease activity.

—>Corticosteroids:used to control severe symptoms or during disease flares.

—>Symptomatic treatment: Depending on the specific symptoms, additional medications or

interventions may be prescribed. For example, diuretics may be used to manage edema, and
beta-blockers or other medications may be prescribed to control palpitations.
//ALGORITHM FOR INITIAL THERAPY OF SLE
PROGNOSIS
varies widely depending on factors
1) disease severity,
2) organ involvement,
3) response to treatment.
With appropriate management, many patients with SLE are able to lead fulfilling lives.

- SLE is a chronic condition that requires lifelong treatment and monitoring.

-Complications such as kidney disease, cardiovascular disease, and infections can occur and may
affect prognosis.

-Early diagnosis and treatment are key to improving outcomes and reducing the risk of
long-term complications.

-Close collaboration between the patient and healthcare team is essential for optimal
management of SLE.
THANK YOU!