【正文】 15:241–250 ? Lupus skin rash often demonstrates inflammatory infiltrates at the dermoepidermal junction and vacuolar change in the basal columnar cells. ? Discoid lesions demonstrate more significant skin inflammation, with hyperkeratosis, follicular plugging, edema, and mononuclear cell infiltration at the dermoepidermal junction. ? In many SLE rashes, immunofluorescent stains demonstrate immunoglobulin and plement deposits at the dermoepidermal basement membrane. Diagnosis ? Systemic lupus erythematosus (SLE) is a diagnosis that must be based on the proper constellation of clinical findings and laboratory evidence. ? The American College of Rheumatology (ACR) criteria summarize features necessary to diagnose SLE: The 1997 revised criteria for the classification of systemic lupus erythematosus (SLE): 1. Malar rash： Fixed malar erythema, flat or raised 2. Discoid rash： Erythematousraised patches with keratotic scaling and follicular plugging。 not diagnostic without clinical features – AntidsDNA High specificity。 sensitivity only 70%。 atrophic scarring may occur in older lesions 3. Photosensitivity: Skin rash as an unusual reaction to sunlight, by patient history or physician observation 4. Oral ulcers: Oral or nasopharyngeal ulcers, usually painless, observed by physician 5. Arthritis: Nonerosive arthritis involving two or more peripheral joints, characterized by tenderness, swelling, or effusion 6. Serositis: a. Pleuritis (convincing history of pleuritic pain or rub heard by physician or evidence of pleural effusion) OR b. Pericarditis (documented by ECG, rub, or evidence of pericardial effusion) 7. Renal : a. Persistent proteinuria ( g/d or 3+) disorder OR b. Cellular casts of any type 8. Neurologic: a. Seizures (in the absence of other causes) disorder OR b. Psychosis (in the absence of other causes) 9. Hematologic: a. Hemolytic anemia disorder OR b. Leukopenia (4,000/mL on two or more occasions) OR c. Lymphopenia (l,500/mL on two or more occasions) OR d. Thrombocytopenia (100,000/mL in the absence of offending drugs) 10. Immunologic disorder: a. Antidoublestranded DNA OR b. AntiSm OR c. Positive finding of antiphospholipid antibodies based on (1) an abnormal serum level of IgG or IgM anticardiolipin antibodies, or (2) a positive test result for lupus anticoagulant using a standard method, or (3) a falsepositive serologic test for syphilis known to be positive for at least 6 months and confirmed by Treponema palliclum immobilization or fluorescent treponemal antibody absorption test 11. Antinuclear antibody: An abnormal titer of antinuclear antibody (ANA) by immunofluorescence or an equivalent assay at any time and in the absence of drugs known to be associated with druginduced lupus syndrome. For identifying patients in clinical studies, a person shall be said to have SLE if any four or more of the 11 criteria are present, either serially or simultaneously, during any interval or observation. This criteria holds a sensitivity of 85% and a specificity of 95%. TREATMENT Medical Care: Care of patients with systemic lupus erythematosus (SLE) depends on individual patient39。 CRP levels change more acutely, and ESR lags behind disease changes. – Complement levels: C3 and C4 levels are often depressed in patients with active SLE because of consumption by immune plex–induced inflammation. In addition, some patients have congenital plement deficiency that predisposes them to SLE. – Complete blood count: Including differential diagnoses, CBC count may help to screen for leucopenia, lymphopenia, anemia, and thrombocytopenia. – Urinalysis/urine protein: Screening tests are used to evaluate for proteinuria ( g/d), hematuria, casts, or pyuria. – Creatinine: Creatinine evaluation is useful to monitor kidney disease activity. – Liver function tests: These may be mildly elevated in acute SLE or in response to therapies such as azathioprine or nonsteroidal antiinflammatory drugs (NSAIDS). – Creatinine kinase: Creatinine kinase levels may be elevated in myositis or overlap syndromes. Imaging Studies ? Joint radiography often provides little evidence of SLE given the absence of erosions, even in the presence of Jaccoud arthropathy with deformity or subluxations. The most mon radiographic changes include periarticular osteopenia and soft tissue swelling. ? Chest radiography and chest CT scans can be used to monitor interstitial lung disease and to assess for pneumonitis, pulmonary emboli, and alveolar hemorrhage. ? Brain MRI/magic resonance angiography (MRA) is used to evaluate CNS lupus for whitematter changes, vasculitis, or stroke, although findings are often nonspecific. ? Echocardiography is used to assess for pericardial effusion, pulmonary hypertension, or verrucous LibmanSacks endocarditis. Procedures ? Lumbar puncture may be performed to exclude infection with fever or neurologic symptoms. Nonspecific elevations in cell count and protein level and decrease in glucose level may be found in the cerebrospinal fluid of patients with CNS lupus. ? Renal biopsy is used to identify the specific type of glomerulonephritis, to aid in prognosis, and to guide treatment. Another benefit of renal biopsy is to distinguish renal lupus from renal thrombosis, which may plicate antiphospholipid antibody