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


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


==Overview==
==Overview==
The most potent risk factor in the development of systemic lupus erythematosus is sex. Other risk factors include [[HLA]] genetic mutations, being African Americans, Asians, and non-Causcasian, and infections.
The most potent [[risk factor]] in the development of systemic lupus erythematosus is gender; females are more likely to develop SLE.<ref name="pmid168962824">{{cite journal |vauthors=Grimaldi CM |title=Sex and systemic lupus erythematosus: the role of the sex hormones estrogen and prolactin on the regulation of autoreactive B cells |journal=Curr Opin Rheumatol |volume=18 |issue=5 |pages=456–61 |year=2006 |pmid=16896282 |doi=10.1097/01.bor.0000240354.37927.dd |url=}}</ref>  Other risk factors include [[HLA]] [[genetic mutations]]; being African American, Asian, or non-Causcasian; and previous exposure to certain [[Infection|infections]].


==Risk Factors==
==Risk Factors==
The underlying cause of this autoimmune disease is not clear. Clinical data shows that the onset of systemic lupus erythematosus is associated with the following factors:
The underlying cause of this autoimmune disease is not clear. Clinical data suggests that the onset of [[systemic lupus erythematosus]] is associated with the following factors:
* Female: SLE affects nine times as many women as men.
* Female gender: [[SLE]] affects women nine times more than men<ref name="urlNIH Fact Sheets - Lupus">{{cite web |url=https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=47 |title=NIH Fact Sheets - Lupus |format= |work= |accessdate=}}</ref><ref name="pmid168962822">{{cite journal |vauthors=Grimaldi CM |title=Sex and systemic lupus erythematosus: the role of the sex hormones estrogen and prolactin on the regulation of autoreactive B cells |journal=Curr Opin Rheumatol |volume=18 |issue=5 |pages=456–61 |year=2006 |pmid=16896282 |doi=10.1097/01.bor.0000240354.37927.dd |url=}}</ref>
* Younger than 50
* Age: Occurs more commonly in people younger than 50
* Race: African Americans, Asians, and non-Causcasian race are affected more often than people from other races
* Race: African Americans, Asians, and other non-Causcasians are affected more often than people of other races<ref name="pmid7575721">{{cite journal |vauthors=McCarty DJ, Manzi S, Medsger TA, Ramsey-Goldman R, LaPorte RE, Kwoh CK |title=Incidence of systemic lupus erythematosus. Race and gender differences |journal=Arthritis Rheum. |volume=38 |issue=9 |pages=1260–70 |year=1995 |pmid=7575721 |doi= |url=}}</ref>
* Drugs
* Drugs: The following drugs carry the greatest risk of developing [[drug-induced lupus erythematosus]]
** [[chlorpromazine]]
** [[Chlorpromazine]]
** [[hydralazine]]
** [[Hydralazine]]
** [[isoniazid]]
** [[Isoniazid]]
** [[methyldopa]]
** [[Methyldopa]]
** [[penicillamine]]
** [[Penicillamine]]
** [[procainamide]]
** [[Procainamide]]
** [[quinidine]]
** [[Quinidine]]
** [[sulfasalazine]]
** [[Sulfasalazine]]
* People with relatives who suffer from [[SLE]], [[rheumatoid arthritis]] or [[thrombotic thrombocytopenic purpura]] are at a slightly higher risk than the general population<ref name="DiGeronimo">DiGeronimo, Theresa. New Hope for People with Lupus. Prima Publishing. 2002.</ref>
* Familial history of:
** [[SLE]]
** [[Rheumatoid arthritis]]
** [[Thrombotic thrombocytopenic purpura]]


* Infections can stimulates some antigen specific cells and lead to SLE disease:
* Infections can stimulate some antigen specific cells and lead to SLE disease:
** [[Epstein Barr virus|Epstein-Barr virus (EBV)]]: may induce anti-DNA antibodies or even lupus-like symptoms. It is associated with higher risk of SLE and also triggering the active course of disease in children
** [[Epstein Barr virus|Epstein-Barr virus (EBV)]] may induce anti-DNA antibodies or even lupus-like symptoms. It is associated with higher risk of SLE and also triggering the active course of disease in children<ref name="pmid23342374">{{cite journal |vauthors=Lossius A, Johansen JN, Torkildsen Ø, Vartdal F, Holmøy T |title=Epstein-Barr virus in systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis—association and causation |journal=Viruses |volume=4 |issue=12 |pages=3701–30 |year=2012 |pmid=23342374 |pmc=3528287 |doi= |url=}}</ref>
** [[Trypanosomiasis]] or [[mycobacterial]] infections may have the same effect as EBV
** [[Trypanosomiasis]] or [[mycobacterial]] infections may have the same effect as [[EBV]]
* [[Ultraviolet]] (UV) light  
* [[Ultraviolet]] (UV) light  
* Cigarette smoking <ref name="pmid11708417">{{cite journal |vauthors=Ghaussy NO, Sibbitt WL, Qualls CR |title=Cigarette smoking, alcohol consumption, and the risk of systemic lupus erythematosus: a case-control study |journal=J. Rheumatol. |volume=28 |issue=11 |pages=2449–53 |year=2001 |pmid=11708417 |doi= |url=}}</ref>
* [[Cigarette smoking]]<ref name="pmid11708417">{{cite journal |vauthors=Ghaussy NO, Sibbitt WL, Qualls CR |title=Cigarette smoking, alcohol consumption, and the risk of systemic lupus erythematosus: a case-control study |journal=J. Rheumatol. |volume=28 |issue=11 |pages=2449–53 |year=2001 |pmid=11708417 |doi= |url=}}</ref>
* Crystalline silica exposure in work environment (e.g. cleaning powders, soil, pottery materials, cement etc.) <ref name="pmid12124868">{{cite journal |vauthors=Parks CG, Cooper GS, Nylander-French LA, Sanderson WT, Dement JM, Cohen PL, Dooley MA, Treadwell EL, St Clair EW, Gilkeson GS, Hoppin JA, Savitz DA |title=Occupational exposure to crystalline silica and risk of systemic lupus erythematosus: a population-based, case-control study in the southeastern United States |journal=Arthritis Rheum. |volume=46 |issue=7 |pages=1840–50 |year=2002 |pmid=12124868 |doi=10.1002/art.10368 |url=}}</ref>
* Crystalline silica exposure in work environment (e.g. cleaning powders, soil, pottery materials, cement, etc.)<ref name="pmid12124868">{{cite journal |vauthors=Parks CG, Cooper GS, Nylander-French LA, Sanderson WT, Dement JM, Cohen PL, Dooley MA, Treadwell EL, St Clair EW, Gilkeson GS, Hoppin JA, Savitz DA |title=Occupational exposure to crystalline silica and risk of systemic lupus erythematosus: a population-based, case-control study in the southeastern United States |journal=Arthritis Rheum. |volume=46 |issue=7 |pages=1840–50 |year=2002 |pmid=12124868 |doi=10.1002/art.10368 |url=}}</ref>
* Drug allergy <ref name="pmid12464374">{{cite journal |vauthors=Cooper GS, Dooley MA, Treadwell EL, St Clair EW, Gilkeson GS |title=Risk factors for development of systemic lupus erythematosus: allergies, infections, and family history |journal=J Clin Epidemiol |volume=55 |issue=10 |pages=982–9 |year=2002 |pmid=12464374 |doi= |url=}}</ref>
* [[Drug allergy]]<ref name="pmid12464374">{{cite journal |vauthors=Cooper GS, Dooley MA, Treadwell EL, St Clair EW, Gilkeson GS |title=Risk factors for development of systemic lupus erythematosus: allergies, infections, and family history |journal=J Clin Epidemiol |volume=55 |issue=10 |pages=982–9 |year=2002 |pmid=12464374 |doi= |url=}}</ref>
* Caring a pet (especially pet dog)
* Caring for a pet (especially a dog)
* Moderate alcohol drinking might be protective for SLE <ref name="pmid18795396">{{cite journal |vauthors=Wang J, Pan HF, Ye DQ, Su H, Li XP |title=Moderate alcohol drinking might be protective for systemic lupus erythematosus: a systematic review and meta-analysis |journal=Clin. Rheumatol. |volume=27 |issue=12 |pages=1557–63 |year=2008 |pmid=18795396 |doi=10.1007/s10067-008-1004-z |url=}}</ref>


* This table must include the cardinal manifestations of differential diagnosis and the list of diseases must be prioritize based on mortality rate and  prevalences of the diseases. For example, if you want to write a differential diagnosis table for  heat stroke, sepsis, malignant hyperthermia, neuroleptic malignant syndrome, and serotonin syndrome first, you need to mention the cardinal manifestations for these conditions as, hyperthermia and altered mental status. Second, prioritize your list based on disease mortality or prevalence then, create the table. You can find the example [[Heat stroke differential diagnosis#Differentiating Heat stroke from other Diseases that may cause hyperthermia and altered mental status|here]].
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 1
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 2
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 3
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 4
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Differential 5
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
| style="padding: 5px 5px; background: #F5F5F5;" |
* On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
|}
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 14:42, 19 October 2018

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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]

Overview

The most potent risk factor in the development of systemic lupus erythematosus is gender; females are more likely to develop SLE.[1] Other risk factors include HLA genetic mutations; being African American, Asian, or non-Causcasian; and previous exposure to certain infections.

Risk Factors

The underlying cause of this autoimmune disease is not clear. Clinical data suggests that the onset of systemic lupus erythematosus is associated with the following factors:

  • Infections can stimulate some antigen specific cells and lead to SLE disease:
  • Ultraviolet (UV) light
  • Cigarette smoking[6]
  • Crystalline silica exposure in work environment (e.g. cleaning powders, soil, pottery materials, cement, etc.)[7]
  • Drug allergy[8]
  • Caring for a pet (especially a dog)
  • This table must include the cardinal manifestations of differential diagnosis and the list of diseases must be prioritize based on mortality rate and prevalences of the diseases. For example, if you want to write a differential diagnosis table for heat stroke, sepsis, malignant hyperthermia, neuroleptic malignant syndrome, and serotonin syndrome first, you need to mention the cardinal manifestations for these conditions as, hyperthermia and altered mental status. Second, prioritize your list based on disease mortality or prevalence then, create the table. You can find the example here.
Differential Diagnosis Similar Features Differentiating Features
Differential 1
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 2
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 3
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 4
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 5
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].

References

  1. ↑ Grimaldi CM (2006). "Sex and systemic lupus erythematosus: the role of the sex hormones estrogen and prolactin on the regulation of autoreactive B cells". Curr Opin Rheumatol. 18 (5): 456–61. doi:10.1097/01.bor.0000240354.37927.dd. PMID 16896282.
  2. ↑ "NIH Fact Sheets - Lupus".
  3. ↑ Grimaldi CM (2006). "Sex and systemic lupus erythematosus: the role of the sex hormones estrogen and prolactin on the regulation of autoreactive B cells". Curr Opin Rheumatol. 18 (5): 456–61. doi:10.1097/01.bor.0000240354.37927.dd. PMID 16896282.
  4. ↑ McCarty DJ, Manzi S, Medsger TA, Ramsey-Goldman R, LaPorte RE, Kwoh CK (1995). "Incidence of systemic lupus erythematosus. Race and gender differences". Arthritis Rheum. 38 (9): 1260–70. PMID 7575721.
  5. ↑ Lossius A, Johansen JN, Torkildsen Ø, Vartdal F, Holmøy T (2012). "Epstein-Barr virus in systemic lupus erythematosus, rheumatoid arthritis and multiple sclerosis—association and causation". Viruses. 4 (12): 3701–30. PMC 3528287. PMID 23342374.
  6. ↑ Ghaussy NO, Sibbitt WL, Qualls CR (2001). "Cigarette smoking, alcohol consumption, and the risk of systemic lupus erythematosus: a case-control study". J. Rheumatol. 28 (11): 2449–53. PMID 11708417.
  7. ↑ Parks CG, Cooper GS, Nylander-French LA, Sanderson WT, Dement JM, Cohen PL, Dooley MA, Treadwell EL, St Clair EW, Gilkeson GS, Hoppin JA, Savitz DA (2002). "Occupational exposure to crystalline silica and risk of systemic lupus erythematosus: a population-based, case-control study in the southeastern United States". Arthritis Rheum. 46 (7): 1840–50. doi:10.1002/art.10368. PMID 12124868.
  8. ↑ Cooper GS, Dooley MA, Treadwell EL, St Clair EW, Gilkeson GS (2002). "Risk factors for development of systemic lupus erythematosus: allergies, infections, and family history". J Clin Epidemiol. 55 (10): 982–9. PMID 12464374.

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