Systemic Lupus Erythematosaus

AMALINA NIKMATULHUSNA C111 13 861

CAHYA RAMDHANI SILA C111 14 010
PUTRI RIZQI A C111 13
HASTRI ADHE R C111 13
 PATIENT IDENTITY
Name : MRS. T
Date of birth : October 6th, 1987
Age : 30 years old
Gender : Female
Address : Bontosallang
Religion : Moeslim
Occupation : Housewife
Marital Status : Married
Hospital/room : Emergency room Wahidin Sudirohusodo
Hospital
 HISTORY TAKING
Main Complaint : Joint pain

Further Anamnesis : A woman 26 year old came to the

Wahidin Hospital with joint pain in all extremities since 7
months ago before admitted to the hospital. It worst in
the last three days before admitted to the hospital. This
pain can not relieved with take a rest. There is no
morning stiffness in this patient. Other complaints such
as the appearance of a rash on her face. Also, there is
erythema appeared on her body and not itchy. It is
become reddish when exposed to the sun. Patients also
complained of hair loss since 7 months ago.
 HISTORY TAKING
No fever. No history of cough. No history of seizure.. And,
there is epigastric pain. There is nausea , but no vomitting
in this patient.

Defecation is normal. No bleeding history. The history was

hospitalized at Labuang Baji and Stella Maris with the same
complaint and got blood transfusion 2 bags at the Stella
Maris Hospital because according to the doctor there is
blood disorders. There is history of consumed unknown
drugs which given by the specialist.
 HISTORY OF DISEASES
• No history of other chronic diseases
• No family history with the same symptoms
 PHYSICAL EXAMINATION
GENERAL DESCRIPTION :
- Impression : Moderate illness
- Nutritional Status : Well nourish
- Consciousness : composmentis

Weight: 45 kg
Height : 155 cm
BMI : 18.7 kg/m2

VITAL SIGN
Blood Pressure : 110/70 mmHg
Heart Rate : 98 x/minute
Respiratory Rate : 20 x/minute
Temperature : 36,5oC
 PHYSICAL EXAMINATION
Head and neck
Face : cyanosis (-), jaundice (-), malar rash(+)
Hair : easy to remove(+)
Eye : anemia (+), icterus (-), conjunctivitis (-),
lag (-), ptosis (-)
Ear : otorrhea (-), tophi (-)
Nose : rhinorrhea (-), epistaxis (-)
Mouth : ulceration (-), oral ulcers (+), bleeding gum (-)
Teeth : dental caries (-)
Tonsil : T1 – T1, hyperemia (-)
Pharynx : hyperemia (-)
Neck : JVP R+0 cmH2O, lymphadenopathy (-), bruit (-)
Cervical : pain (-), tenderness (-), sign of inflammation (-)
Thyroid gland : enlargement (-)
 PHYSICAL EXAMINATION
THORAX
I : symmetry left and right,
P : normal vocal fremitus, mass (-), tenderness (-)
P : resonant
A : vesicular breath sound, rales (-), wheezing (-)
HEART
I : ictus cordis not visible
P : thrill not palpable
P : normal heart borders
A : normal S I/II heart sound, additional sound (-)
ABDOMEN
I : distension (-), morbiliform rash
A : normal
P : hepatomegaly (-), splenomegaly (-), mass(-), tenderness (-),
P : tympany (+), ascites (-)
 RHEUMATOLOGY EXAMINATION

GAIT : Normal
ARM : Normal morbiliform rash
LEG : Normal morbiliform rash
SPINE : Normal
PHYSICAL EXAMINATION
PHYSICAL EXAMINATION
 Laboratorium Examination
Laboratorium result
Leukosit 8.100 4.000 – 11.000/uL
Eritrosit 3,91 x 106 4,5 – 5,5 x 106 /uL
Hemoglobin 10,3 12,0 – 16,0 g/dL
Hematokrit 34 40 – 50 %
Trombosit 329.000 150.000 – 450.000
Neutrofil 62,7 50 – 70 %
Limfosit 19,9 20-40 %
Monosit 7,9 2-8 %
LED 22 <20 mm/jam
Albumin 2,6 3,5-5,0 gr/dl
 Laboratorium Examination
Laboratorium result
Ureum 27 mg/dl 10 – 50 mg/dl
Creatinin 1,25 mg/dl <1,1 mg/dl
EGFR 55,2 ml/min/1,73 m2
SGOT 18 U/L <38 U/L
SGPT 57 U/L <41 U/L
Sodium 142 mmol/L 136-145 mmol/L
Potassium 4,1 mmol/L 3,5-5,1 mmol/L
Chlorida 102 mmol/L 97 – 111 mmol/L
Uric acid 3,4 mg/dl 3,4 – 7,0 mg/dl
Urinalisis
Color yellow
pH 6,0
Spesific Gravity 1,015
Glucose neg
Protein ++
Urobilinogen normal
Keton neg
Blood neg
Bilirubin neg
Nitrit neg
Leucosite neg
Vit. C neg
Sedimen neg
 ASSESMENT
- Mild or moderate Systemic Lupus Erythematosus
- Hipoalbuminemia
 PLANNING
• Anti Nuclear Antibody (ANA) test
• Anti Nuclear Antibody (ANA) profile
• Erythrocyte Sedimentation Rate (ESR)
• Foto thorax
 THERAPY
• Pharmacology
• Metylprednisolone 4 mg/8 hours/oral
• Omeprazole 20 mg/24 hours/oral
 PROBLEM LIST
Planning Treatment
1. Systemic lupus erythematosus -ANA test Methylprednis
-ANA profile olone 4 mg / 8
Based on: -Erythrocyte hours/ oral
Based on ACR1997 classification Sedimentation
criteria Rate (ESR) Omeprazole
- Malar rash -Foto thorax 20 mg /24
- Photosensitifity hours /oral
- Arthritis
- Hematologic disorders

Total score : 4 (without

laboratory finding)
 DEFINITION

Systemic lupus erythematosus (SLE) is an autoimmune disease in

which organs and cells undergo damage initially mediated by
tissue-binding autoantibodies and immune complexes, marked by
autoantibody against nucleus and involve multiple organ. In most
patients, autoantibodies are present for a few years before the first
clinical symptom appears.

Symptoms vary from person to person, and may come and go,
depend on what part of the body is affected, can be mild,
moderate, or severe. Diagnosis can be difficult because lupus
mimics many other diseases; it requires clinical and serologic
criteria.
Kasper D et al, 2015. (Harrison’s Principle of Internal Medicine, 19th ed.)
 EPIDEMIOLOGY

• Ninety percent of patients are women of child-

bearing years; people of all genders, ages, and
ethnic groups are susceptible.
• Prevalence of SLE in the United States is 20 to
150 per 100,000 women depending on race and
gender; highest prevalence is in African-
American and Afro-Caribbean women, and
lowest prevalence is in white men.
Kasper D et al, 2015. (Harrison’s Principle of Internal Medicine, 19th ed.)
PATOPHYSIOLOGY

Kasper D et al, 2015. (Harrison’s Principle of Internal Medicine, 19th ed.)

Kasper D et al, 2015. (Harrison’s Principle of Internal Medicine, 19th ed.)
ACR 1997 Criteria for Systemic Lupus
Erythematous

SCORE 4 (without laboratory finding)

 With no, mild, and/or moderate
organ manifestations (e.g., skin,
joints, serositis)
Indication Medication Dosage

First line and basic Hydroxychloroquine •≤ 6.0–6.5 mg/kg ideal body

treatment or weight/day
Chloroquine
≤ 3.5–4.0 mg/kg ideal body
weight/day
If indicated, initial non-
steroidal anti-inflammatory
drugs
and/or
glucocorticoids
If no response or no Azathioprine 2–3 mg/kg body weight/day
reduction of glucocorticoids or
≤ 7.5 mg possible in the long methotrexate 15–20 mg/week (preferably
term s.c.)
or
*
mycophenolate mofetil 2 g/day
The European League Against Rheumatism (EULAR), 2008.
Classification
 PROGNOSIS

Although current treatment of lupus has improved

survival dramatically, prolonged and complete remission
(defined as 5 years without clinical and laboratory
evidence of active disease and on no treatment) has
remained elusive for most patients.

Moreover, a significant number of patients (10–20% in

tertiary referral centres) do not respond adequately to
immunosuppressive therapies.
The European League Against Rheumatism (EULAR), 2012.
THANK YOU