【正文】 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 syndrome and require anticoagulation rather than immunomodulatory therapy. ? Skin biopsy can help to diagnose SLE or unusual rashes in patients with SLE. Histologic Findings ? Renal biopsy confirms the presence of lupus nephritis, aids classification of SLE nephritis, and guides therapeutic decisions. ? The classification for lupus nephritis is based on light microscopy, electron microscopy, and immunofluorescence findings. ? The following is the International Society of Nephrology 2022 revised classification of SLE nephritis: Weening JJ, et al. J Am Soc Nephrol 2022。 associated with neonatal lupus Antiribosomal P Unmon antibodies that may correlate with lupus cerebritis AntiRNP indicate mixed connective tissue disease with overlap SLE, scleroderma, and myositis Anticardiolipin used to screen for antiphospholipid antibody syndrome ? Lupus anticoagulant Multiple tests (eg, Direct Russell Viper Venom test) to screen for inhibitors in the clotting cascade in antiphospholipid antibody syndrome ? Coombs test Coombs test–positive anemia to denote antibodies on RBCs ? Antihistone Druginduced lupus (DIL) ANA antibodies often this type (eg, with procainamide or hydralazine。 only 3040% sensitivity – AntiSSA (Ro) or AntiSSB (La) Present in 15% of patients with SLE and other connective tissue diseases such as Sj246。 sensitivity only 70%。 sensitivity 95%。Systemic Lupus Erythematosus Dr. Ye yujin Rheumatology department The 1st Affiliated Hospital of Sun YatSen University 20221230 Background: Systemic lupus erythematosus (SLE) 1) A chronic, multifaceted inflammatory autoimmune disease 2) Affect every an system of the body 3) SLE is protean in its manifestations and follows a relapsing and remitting course Epidemiology and Etiology Pathophysiology Clinical features Treatment Epidemiology and Etiology Frequency Worldwide , the prevalence of SLE varies with ethnicity and geographical locations: 70100 cases per 100,000 population in China. 50 cases per 100,000 population in the US, while 200 cases in the AfricanAmerican women. 12 cases per 100,000 population in Britain 39 cases per 100,000 population in Sweden Sex Hormonal factors are important in the pathogenesis of the disease: ? In women of reproductive age , incidence of SLE is 6 to 10 fold higher than men. ? Additionally, pregnancy and administration of exogenous estrogen often precipitate exacerbations of SLE. ? Men at all ages have a risk of disease similar to that of women who are prepubertal or postmenopausal. Age ? Disease incidence is highest among women aged 1464 years, because of female sex hormone production. ? Males do not have an agerelated peak in incidence. Causes ? Although the specific cause of SLE is unknown, multiple factors are associated with the development of the disease. ? These include geic, racial, hormonal, and environmental factors. ? At least 10 different gene loci are known to increase the risk for SLE. – A geic predisposition is supported by the 10fold increase in concordance among monozygotic twins versus dizygotic twins. – Studies of the human leukocyte antigens (HLA) reveal that HLADR2 and HLADR3 occur more often in people with SLE than in the general population. Geic factors – The presence of the null plement alleles and congenital deficiencies of plement (es