Systemic lupus erythematosus classification scheme: Difference between revisions

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{{Systemic lupus erythematosus}}
{{Systemic lupus erythematosus}}


{{CMG}}; {{AE}} {{RT}} {{KS}}
{{CMG}}; {{AE}} {{MIR}}, {{RT}}, {{KS}}


==Overview==
==Overview==


Lupus is a chronic [[Autoimmunity|autoimmune disease]] in which the body's own defense system attacks otherwise healthy tissue.  
[[Lupus]] may be classified into several subtypes according to clinical features, including [[systemic lupus erythematosus]], [[cutaneous lupus erythematosus]], [[Drug-induced lupus erythematosus|drug-induced lupus]], and [[Neonatal lupus erythematosus|neonatal lupus]]. [[Systemic lupus erythematosus]] ([[SLE]]) itself may be classified into several subtypes based on [[Dermatology|dermatologic]] manifestations or [[glomerulonephritis]]. [[SLE]] may be classified according to [[Dermatology|dermatologic]] manifestations into 4 subtypes: acute cutaneous lupus erythematosus (ACLE), [[subacute]] cutaneous lupus erythematosus (SCLE), chronic cutaneous lupus erythematosus (CCLE), and intermittent cutaneous lupus erythematosus (ICLE). SLE may be classified according to [[glomerulonephritis]] into 6 subtypes: minimal mesangial lupus nephritis (class I), mesangial proliferative lupus nephritis (class II), focal lupus nephritis (class III), diffuse lupus nephritis (class IV), lupus membranous nephropathy (class V), and advanced sclerosing lupus nephritis (class VI).
Clinically, it can affect multiple organ systems including the heart, skin, joints, kidneys and nervous system.


==Classification==
==Classification==
: Systemic lupus erythematosus may be classified into several subtypes based on glomerulonephritis, dermatologic features, and [classification method 2], and [classification method 3].
 
: SLE may be classified according to dermatologic manifestations into 3 subtypes: acute cutaneous lupus erythematosus (ACLE), subacute cutaneous lupus erythematosus (SCLE), and chronic cutaneous lupus erythematosus (CCLE)
=== Classification of lupus based on clinical characteristics ===
: SLE may be classified according to glomerulonephritis into 6 subtypes: minimal mesangial lupus nephritis (class I), mesangial proliferative lupus nephritis (class II), focal lupus nephritis (class III), diffuse lupus nephritis (class IV), lupus membranous nephropathy (class V), and advanced sclerosing lupus nephritis (class VI).
Lupus may be classified into the following types based on clinical characteristics:<ref name="pmid17060022">{{cite journal |vauthors=Lee HJ, Sinha AA |title=Cutaneous lupus erythematosus: understanding of clinical features, genetic basis, and pathobiology of disease guides therapeutic strategies |journal=Autoimmunity |volume=39 |issue=6 |pages=433–44 |date=September 2006 |pmid=17060022 |doi=10.1080/08916930600886851 |url=}}</ref>
:
* [[Systemic lupus erythematosus]] (SLE)
:
* [[Cutaneous lupus erythematosus]] (CLE)
: SLE may be classified according to dermatologic manifestations into 3 subtypes: acute cutaneous lupus erythematosus (ACLE), subacute cutaneous lupus erythematosus (SCLE), and chronic cutaneous lupus erythematosus (CCLE)
* [[Drug-induced lupus erythematosus|Drug-induced lupus]]
:* SLE classification according to dermatologic manifestations:
* [[Neonatal lupus]]
:** Acute cutaneous lupus erythematosus (ACLE)
=== Classification of SLE based on dermatologic manifestations ===
:** Subacute cutaneous lupus erythematosus (SCLE)
[[SLE]] may be further classified according to [[Dermatology|dermatologic]] manifestations into 4 subtypes:<ref name="pmid17060022">{{cite journal |vauthors=Lee HJ, Sinha AA |title=Cutaneous lupus erythematosus: understanding of clinical features, genetic basis, and pathobiology of disease guides therapeutic strategies |journal=Autoimmunity |volume=39 |issue=6 |pages=433–44 |year=2006 |pmid=17060022 |doi=10.1080/08916930600886851 |url=}}</ref><ref name="pmid18094949">{{cite journal |vauthors=Lin JH, Dutz JP, Sontheimer RD, Werth VP |title=Pathophysiology of cutaneous lupus erythematosus |journal=Clin Rev Allergy Immunol |volume=33 |issue=1-2 |pages=85–106 |year=2007 |pmid=18094949 |doi=10.1007/s12016-007-0031-x |url=}}</ref><ref name="pmid1570517">{{cite journal |vauthors=Wallace DJ, Pistiner M, Nessim S, Metzger AL, Klinenberg JR |title=Cutaneous lupus erythematosus without systemic lupus erythematosus: clinical and laboratory features |journal=Semin. Arthritis Rheum. |volume=21 |issue=4 |pages=221–6 |year=1992 |pmid=1570517 |doi= |url=}}</ref>
:** Chronic cutaneous lupus erythematosus (CCLE)
* Acute cutaneous lupus erythematosus (ACLE)
:** Intermittent cutaneous lupus erythematosus (ICLE) {| class="wikitable" ! !subtypes ! ! |- |Acute cutaneous lupus erythematosus (ACLE) |
* Subacute cutaneous lupus erythematosus (SCLE)
* Localized ACLE (ie, malar rash, butterfly rash)
* Chronic cutaneous lupus erythematosus (CCLE)
* Intermittent cutaneous lupus erythematosus (ICLE)
{| class="wikitable"
! style="background: #4479BA; color: #FFFFFF; " align="center" |Subtypes
! style="background: #4479BA; color: #FFFFFF; " align="center" |Manifestation/subclass
|-
| style="background: #DCDCDC; " |Acute cutaneous lupus erythematosus (ACLE)
|
* Localized ACLE (i.e., [[malar rash]], [[butterfly rash]])
* Generalized ACLE
* Generalized ACLE
* Toxic epidermal necrolysis-like ACLE | | |- |Subacute cutaneous lupus erythematosus (SCLE) |
* [[Toxic epidermal necrolysis]]-like ACLE
|-
| style="background: #DCDCDC; " |Subacute cutaneous lupus erythematosus (SCLE)
|
* Annular SCLE
* Annular SCLE
* Papulosquamous SCLE
* [[Papulosquamous|Papulosquamous SCLE]]
* Drug-induced SCLE
* [[Drug-induced]] SCLE
* [[Neonatal]] lupus ([[dermatitis]] manifestations)
* Less common subtypes:
* Less common subtypes:
** Erythrodermic
** [[Erythroderma|Erythrodermic]]
** Poikilodermatous
** Poikilodermatous
** Erythema multiforme-like (Rowell syndrome)
** [[Erythema multiforme|Erythema multiforme-like]] (Rowell syndrome)
** Vesiculobullous annular SCLE | | |- |Chronic cutaneous lupus erythematosus (CCLE) |
** Vesiculobullous annular SCLE
* Discoid lupus erythematosus (DLE)
|-
** Localized DLE
| style="background: #DCDCDC; " |Chronic cutaneous lupus erythematosus (CCLE)
|
* [[Discoid lupus erythematosus]] (DLE)
** [[Localized oedema|Localized]] DLE
** Generalized DLE
** Generalized DLE
** Hypertrophic DLE
** [[Hypertrophic]] DLE
* Lupus erythematosus tumidus (LE tumidus)
* Lupus erythematosus tumidus (LE tumidus)
* Lupus profundus (also known as lupus panniculitis)
* Lupus profundus (also known as lupus panniculitis)
* Chilblain lupus erythematosus (chilblain LE)
* [[Chilblain]] lupus erythematosus (chilblain LE)
* Lichenoid cutaneous lupus erythematosus-lichen planus overlap syndrome (LE-LP overlap syndrome) | | |- |Intermittent cutaneous lupus erythematosus (ICLE) |
* Lichenoid cutaneous lupus erythematosus-[[lichen planus]] overlap syndrome (LE-LP overlap syndrome)
* A consistent histopathologic feature of ACLE, SCLE, and discoid lupus erythematosus | | |}
|-
:
| style="background: #DCDCDC; " |Intermittent cutaneous lupus erythematosus (ICLE)
:
|
* A consistent [[histopathologic]] feature of ACLE, SCLE, and [[discoid lupus erythematosus]]
|}
 
=== Classification of SLE based on glomerulonephritis ===
SLE may be classified according to the degree of [[glomerulonephritis]] into 6 subtypes:<ref name="pmid12858447">{{cite journal |vauthors=Mannik M, Merrill CE, Stamps LD, Wener MH |title=Multiple autoantibodies form the glomerular immune deposits in patients with systemic lupus erythematosus |journal=J. Rheumatol. |volume=30 |issue=7 |pages=1495–504 |year=2003 |pmid=12858447 |doi= |url=}}</ref><ref name="pmid14530779">{{cite journal |vauthors=Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR |title=Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients |journal=Medicine (Baltimore) |volume=82 |issue=5 |pages=299–308 |year=2003 |pmid=14530779 |doi=10.1097/01.md.0000091181.93122.55 |url=}}</ref><ref name="pmid14717922">{{cite journal |vauthors=Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M |title=The classification of glomerulonephritis in systemic lupus erythematosus revisited |journal=Kidney Int. |volume=65 |issue=2 |pages=521–30 |year=2004 |pmid=14717922 |doi=10.1111/j.1523-1755.2004.00443.x |url=}}</ref>
* Minimal mesangial [[lupus nephritis]] (class I)
* Mesangial proliferative [[lupus nephritis]] (class II)
* Focal [[lupus nephritis]] (class III)
* Diffuse [[lupus nephritis]] (class IV)
* [[Membranous nephropathy|Lupus membranous nephropathy]] (class V)
* Advanced sclerosing [[lupus nephritis]] (class VI)
{| class="wikitable"
{| class="wikitable"
! style="background: #4479BA; color: #FFFFFF; " align="center" |Subtype
! style="background: #4479BA; color: #FFFFFF; " align="center" |Manifestation/subclass
|-
| style="background: #DCDCDC; " |Minimal mesangial [[lupus nephritis]] (class I)
|
* The earliest and mildest form of [[Glomerulus|glomerular]] involvement
* Normal [[urinalysis]], no or minimal [[proteinuria]], and a normal serum [[creatinine]]
|-
|-
|Minimal mesangial lupus nephritis (class I)
| style="background: #DCDCDC; " |Mesangial proliferative [[lupus nephritis]] (class II)
|the earliest and mildest form of glomerular involvement
normal urinalysis, no or minimal proteinuria, and a normal serum creatinine
 
mesangial immune deposits that are identified by immunofluorescence alone or by both immunofluorescence and electron microscopy, but such patients do not have light microscopic abnormalities
|
|
* [[hematuria|Microscopic hematuria]] and/or [[proteinuria]]
|-
|-
|Mesangial proliferative lupus nephritis (class II)
| style="background: #DCDCDC; " |Focal [[lupus nephritis]] (class III)
|microscopic hematuria and/or proteinuria
Light microscope:
 
mesangial hypercellularity (of any degree) or mesangial matrix expansion
 
A few isolated subepithelial or subendothelial deposits may be seen on immunofluorescence or electron microscopy
|
|
* [[Hematuria]] and [[proteinuria]]
* May also have [[hypertension]], a decreased [[Glomerular filtration rate|glomerular filtration rate,]] and/or [[nephrotic syndrome]]
|-
|-
|Focal lupus nephritis (class III)
| style="background: #DCDCDC; " |Diffuse [[lupus nephritis]] (class IV)
|hematuria and proteinuria
|
may also have hypertension, a decreased glomerular filtration rate, and/or nephrotic syndrome
* Most common and most severe form


Light microscopy: Active or inactive endocapillary or extracapillary segmental glomerulonephritis (Less than 50 percent of glomeruli are affected)
* [[Hematuria]] and [[proteinuria]]
 
* [[Nephrotic syndrome]], [[hypertension]], and reduced [[glomerular filtration rate]]
Electron microscopy: immune deposits in the subendothelial space of the glomerular capillary and mesangium
* [[Hypocomplementemia]] (especially C3) and elevated anti-DNA levels, especially during active disease<ref name="pmid7231154">{{cite journal |vauthors=Lloyd W, Schur PH |title=Immune complexes, complement, and anti-DNA in exacerbations of systemic lupus erythematosus (SLE) |journal=Medicine (Baltimore) |volume=60 |issue=3 |pages=208–17 |year=1981 |pmid=7231154 |doi= |url=}}</ref>
 
|-
Glomeruli affected by fibrinoid necrosis and crescents
| style="background: #DCDCDC; " |Lupus membranous [[nephropathy]] (class V) 
 
|
Presence of tubulointerstitial or vascular abnormalities
* [[Hematuria]] and [[proteinuria]]
|Class III (A)=focal proliferative lupus nephritis
* [[Nephrotic syndrome]], [[hypertension]], and reduced [[glomerular filtration rate]]
class III disease with active lesions
* [[Hypocomplementemia]]
 
Class III (C)=focal sclerosing lupus nephritis
 
chronic inactive lesions with scarring
|-
|-
|Diffuse lupus nephritis (class IV)
| style="background: #DCDCDC; " |Advanced sclerosing [[lupus nephritis]] (class VI)
|most common and most severe form
|
Hematuria and proteinuria
* Slowly progressive [[renal dysfunction]]
 
nephrotic syndrome, hypertension, and reduced glomerular filtration rate
 
hypocomplementemia (especially C3) and elevated anti-DNA levels, especially during active disease 7231154
 
Light microscopy: more than 50 percent of glomeruli are affected that display endocapillary with or without extracapillary glomerulonephritis and Mesangial abnormalities
 
Electron microscopy: subendothelial deposits, at least during the active phase and diffuse wire loop deposits, but with little or no glomerular proliferation
|This class is classified based on the tissue involvement to segmentally (S) or globally (G), and based on the inflammatory activity (or chronicity) of the lesions into 6 subclasses include:
 
Class IV-S (A)
 
Class IV-G (A)


Class IV-S (A/C)
* [[Proteinuria]]
 
Class IV-G (A/C)
 
Class IV-S (C)
 
Class IV-G (C)
|}
|}
Systemic lupus erythematosus, or SLE, is the most common form of lupus.
Discoid lupus erythematosus causes a skin rash that doesn't go away.
Subacute cutaneous lupus erythematosus causes skin sores on areas of the body exposed to the sun.
Neonatal lupus affects newborns.
Drug-induced lupus can be caused by certain medicines.
There are several types of lupus; in general, when the word lupus alone is used, reference is to systemic lupus erythematosus. different manifestion  Other types include:<ref name="Andrews">James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. Chapter 8. ISBN 0721629210.</ref>
*Chronic cutaneous lupus erythematosus
**[[Discoid lupus erythematosus]], a skin disorder that causes a red, raised rash on the face and scalp. Discoid lupus occasionally (1–5%) develops into SLE.<ref>[http://www.skinsite.com/info_discoid_lupus_erythematosus.htm Discoid Lupus Erythematosus]</ref>
***Localized discoid lupus erythematosus
***Generalized discoid lupus erythematosus
***Childhood discoid lupus erythematosus
**Chilblain lupus erythematosus (Hutchinson)
**Lupus erythematosus-lichen planus overlap syndrome
**Lupus erythematosus panniculitis (Lupus erythematosus profundus)
**Subacute cutaneous lupus erythematosus, which causes nonscarring skin [[lesions]] on patches of skin exposed to sunlight.<ref name="niams">{{cite web |url=http://www.niams.nih.gov/Health_Info/Lupus/default.asp |title=Handout on Health: Systemic Lupus Erythematosus |accessdate=2007-11-23 |month=August | year=2003 |work=The National Institute of Arthritis and Musculoskeletal and Skin Diseases |publisher=National Institutes of Health}}</ref>
**Tumid lupus erythematosus
**Verrucous lupus erythematosus (Hypertrophic lupus erythematosus)
*Neonatal lupus erythematosus, a rare disease affecting babies born to women with SLE, [[Sjögren's syndrome]], or sometimes no autoimmune disorder. It is theorized that maternal antibodies attack the fetus, causing skin rash; liver problems; low blood counts, which gradually fade; and heart block, leading to [[bradycardia]].<ref name="niams" />
*Childhood systemic lupus erythematosus, the pediatric variant of systemic lupus erythematosus.
*[[Drug-induced lupus erythematosus]], a drug-induced form of SLE; this type of lupus can occur equally in either gender.
*[[Lupus nephritis]], an inflammation of the [[kidney]]s caused by SLE
*Complement deficiency syndromes
==Diagnosis==
===Physical Examination===
====Skin====
=====Lupus Erythematosus Chronicus Disseminatus Superficialis=====
======Face======
<gallery>
Image:Lupus erythematosus chronicus disseminatus superficialis11.jpg|Lupus erythematosus chronicus disseminatus superficialis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus disseminatus superficialis08.jpg|Lupus erythematosus chronicus disseminatus superficialis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus disseminatus superficialis07.jpg|Lupus erythematosus chronicus disseminatus superficialis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus disseminatus superficialis06.jpg|Lupus erythematosus chronicus disseminatus superficialis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus disseminatus superficialis05.jpg|Lupus erythematosus chronicus disseminatus superficialis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus disseminatus superficialis03.jpg|Lupus erythematosus chronicus disseminatus superficialis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus disseminatus superficialis02.jpg|Lupus erythematosus chronicus disseminatus superficialis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
======Trunk======
<gallery>
Image:Lupus erythematosus chronicus disseminatus superficialis01.jpg|Lupus erythematosus chronicus disseminatus superficialis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
======Extremity======
<gallery>
Image:Lupus erythematosus chronicus disseminatus superficialis09.jpg|Lupus erythematosus chronicus disseminatus superficialis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus disseminatus superficialis10.jpg|Lupus erythematosus chronicus disseminatus superficialis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus disseminatus superficialis04.jpg|Lupus erythematosus chronicus disseminatus superficialis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
=====Lupus Erythematosus Chronicus Verrrucous=====
======Extremity======
<gallery>
Image:Lupus erythematosus chronicus verrucous03.jpg|Lupus erythematosus chronicus verrucous. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus verrucous04.jpg|Lupus erythematosus chronicus verrucous. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus verrucous05.jpg|Lupus erythematosus chronicus verrucous. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus verrucous06.jpg|Lupus erythematosus chronicus verrucous. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus verrucous07.jpg|Lupus erythematosus chronicus verrucous. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus verrucous08.jpg|Lupus erythematosus chronicus verrucous. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
======Trunk======
<gallery>
Image:Lupus erythematosus chronicus verrucous01.jpg|Lupus erythematosus chronicus verrucous. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus chronicus verrucous02.jpg|Lupus erythematosus chronicus verrucous. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
=====Lupus Erythematosus Profundus=====
======Extremity======
<gallery>
Image:Lupus erythematosus profundus01.jpg|Lupus erythematosus profundus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lupus erythematosus profundus02.jpg|Lupus erythematosus profundus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
=====Subacute Cutaneous Lupus Erythematosus=====
======Face======
<gallery>
Image:Subacute cutaneous lupus erythematosus01.jpg|Subacute cutaneous lupus erythematosus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Subacute cutaneous lupus erythematosus02.jpg|Subacute cutaneous lupus erythematosus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Subacute cutaneous lupus erythematosus05.jpg|Subacute cutaneous lupus erythematosus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Subacute cutaneous lupus erythematosus07.jpg|Subacute cutaneous lupus erythematosus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
======Head======
<gallery>
Image:Subacute cutaneous lupus erythematosus06.jpg|Subacute cutaneous lupus erythematosus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
======Trunk======
<gallery>
Image:Subacute cutaneous lupus erythematosus03.jpg|Subacute cutaneous lupus erythematosus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Subacute cutaneous lupus erythematosus04.jpg|Subacute cutaneous lupus erythematosus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
=====Systemic Lupus Erythematosus=====
======Face======
<gallery>
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==References==
==References==

Latest revision as of 14:22, 26 June 2018

Systemic lupus erythematosus Microchapters

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Systemic lupus erythematosus classification scheme On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2], Raviteja Guddeti, M.B.B.S. [3], Kiran Singh, M.D. [4]

Overview

Lupus may be classified into several subtypes according to clinical features, including systemic lupus erythematosus, cutaneous lupus erythematosus, drug-induced lupus, and neonatal lupus. Systemic lupus erythematosus (SLE) itself may be classified into several subtypes based on dermatologic manifestations or glomerulonephritis. SLE may be classified according to dermatologic manifestations into 4 subtypes: acute cutaneous lupus erythematosus (ACLE), subacute cutaneous lupus erythematosus (SCLE), chronic cutaneous lupus erythematosus (CCLE), and intermittent cutaneous lupus erythematosus (ICLE). SLE may be classified according to glomerulonephritis into 6 subtypes: minimal mesangial lupus nephritis (class I), mesangial proliferative lupus nephritis (class II), focal lupus nephritis (class III), diffuse lupus nephritis (class IV), lupus membranous nephropathy (class V), and advanced sclerosing lupus nephritis (class VI).

Classification

Classification of lupus based on clinical characteristics

Lupus may be classified into the following types based on clinical characteristics:[1]

Classification of SLE based on dermatologic manifestations

SLE may be further classified according to dermatologic manifestations into 4 subtypes:[1][2][3]

  • Acute cutaneous lupus erythematosus (ACLE)
  • Subacute cutaneous lupus erythematosus (SCLE)
  • Chronic cutaneous lupus erythematosus (CCLE)
  • Intermittent cutaneous lupus erythematosus (ICLE)
Subtypes Manifestation/subclass
Acute cutaneous lupus erythematosus (ACLE)
Subacute cutaneous lupus erythematosus (SCLE)
Chronic cutaneous lupus erythematosus (CCLE)
Intermittent cutaneous lupus erythematosus (ICLE)

Classification of SLE based on glomerulonephritis

SLE may be classified according to the degree of glomerulonephritis into 6 subtypes:[4][5][6]

Subtype Manifestation/subclass
Minimal mesangial lupus nephritis (class I)
Mesangial proliferative lupus nephritis (class II)
Focal lupus nephritis (class III)
Diffuse lupus nephritis (class IV)
  • Most common and most severe form
Lupus membranous nephropathy (class V) 
Advanced sclerosing lupus nephritis (class VI)

References

  1. ↑ 1.0 1.1 Lee HJ, Sinha AA (September 2006). "Cutaneous lupus erythematosus: understanding of clinical features, genetic basis, and pathobiology of disease guides therapeutic strategies". Autoimmunity. 39 (6): 433–44. doi:10.1080/08916930600886851. PMID 17060022.
  2. ↑ Lin JH, Dutz JP, Sontheimer RD, Werth VP (2007). "Pathophysiology of cutaneous lupus erythematosus". Clin Rev Allergy Immunol. 33 (1–2): 85–106. doi:10.1007/s12016-007-0031-x. PMID 18094949.
  3. ↑ Wallace DJ, Pistiner M, Nessim S, Metzger AL, Klinenberg JR (1992). "Cutaneous lupus erythematosus without systemic lupus erythematosus: clinical and laboratory features". Semin. Arthritis Rheum. 21 (4): 221–6. PMID 1570517.
  4. ↑ Mannik M, Merrill CE, Stamps LD, Wener MH (2003). "Multiple autoantibodies form the glomerular immune deposits in patients with systemic lupus erythematosus". J. Rheumatol. 30 (7): 1495–504. PMID 12858447.
  5. ↑ Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR (2003). "Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients". Medicine (Baltimore). 82 (5): 299–308. doi:10.1097/01.md.0000091181.93122.55. PMID 14530779.
  6. ↑ Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M (2004). "The classification of glomerulonephritis in systemic lupus erythematosus revisited". Kidney Int. 65 (2): 521–30. doi:10.1111/j.1523-1755.2004.00443.x. PMID 14717922.
  7. ↑ Lloyd W, Schur PH (1981). "Immune complexes, complement, and anti-DNA in exacerbations of systemic lupus erythematosus (SLE)". Medicine (Baltimore). 60 (3): 208–17. PMID 7231154.

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