HHE Rheumatology 2019 | Page 8

TABLE 4 Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) Weight Item Description 8 Seizure 8 Psychosis Organic brain syndrome 8 Visual 8 8 Cranial nerve 8 Lupus headache 8 Cerebrovascular accident Vasculitis 8 Arthritis 4 4 Myositis 4 Casts 4 Haematuria Proteinuria 4 Pyuria 4 2 New malar rash 2 Alopecia 2 Mucous membranes 2 Pleurisy 2 Pericarditis 2 Low complement 2 Increased DNA binding 1 Fever 1 Thrombocytopaenia 1 Leukopaenia Recent onset. Exclude metabolic, infectious, or drug-related causes Altered ability to function in normal activity due to severe disturbance in the perception of reality. Includes hallucinations; incoherence; marked loose associations; impoverished thought content; marked illogical thinking; bizarre, disorganised or catatonic behaviour. Exclude the presence of uraemia and offending drugs Altered mental function with impaired orientation or impaired memory or syndrome other intellectual function, with rapid onset and fluctuating clinical features. Includes a clouding of consciousness with a reduced capacity to focus and an inability to sustain attention on environment, and at least two of the following: perceptual disturbance, incoherent speech, insomnia or daytime drowsiness, increased or decreased psychomotor activity. Exclude metabolic, infectious, and drug-related causes Retinal changes from systemic lupus erythematosus: cytoid bodies, retinal haemorrhages, serous exudates or haemorrhages in the choroid, optic neuritis (not due to hypertension, drugs, or infection) New onset of a sensory or motor neuropathy involving a cranial nerve Severe, persistent headache; may be migranous; unresponsive to narcotics New syndrome. Exclude arteriosclerosis Ulceration, gangrene, tender finger nodules, periungual infarction, splinter haemorrhages. Vasculitis confirmed by biopsy or angiogram More than two joints with pain and signs of inflammation Proximal muscle aching or weakness associated with elevated creatine phosphokinase/aldolase levels, electromyographic changes, or a biopsy showing myositis Heme, granular, or erythrocyte More than 5 erythrocytes per high power field. Exclude other causes (stone, infection) More than 0.5g urinary protein excreted per 24h. New onset or recent increase of >0.5g/24h More than five leukocytes per high-power field. Exclude infection New onset or recurrence of an inflammatory type of rash New or recurrent. A patch of abnormal, diffuse hair loss New onset or recurrence of oral or nasal ulcerations Pleuritic chest pain with pleural rub or effusion, or pleural thickening Pericardial pain with at least one of rub or effusion. Confirmation by electro- or echocardiography A decrease in CH50, C3, or C4 level (to less than the lower limit of the laboratory-determined normal range) More than 25% binding by Farr assay (to >the upper limit of the laboratory-determined normal range, for example, 25%) More than 38ºC after the exclusion of infection Fewer than 100,000 platelets Leukocyte count of <3000/mm 3 (not due to drugs) well as promp recognition and treatment. Patients with SLE should receive vaccinations as proposed by EULAR in the recommendations for vaccination of patients with autoimmune rheumatic diseases. 24 Seasonal influenza and pneumococcal vaccination are strongly recommended for patients with SLE, preferably during stable disease. 24,26 Live attenuated vaccines are not recommended in patients chronically treated with immunosuppressant therapies because of the risk of disseminated infections. Osteoporosis Osteopaenia and osteoporosis are frequent comorbidities in SLE patients and the disease 8 HHE 2019 | hospitalhealthcare.com itself represents an independent risk factor for low bone mineral density (BMD), but there are additional risk factors that may concur, such as therapy with glucocorticoids and the high prevalence of vitamin D insufficiency or deficiency, 27 favoured also by the doctor’s prescribed lifestyle. BMD score should be evaluated at disease onset, and the ongoing EULAR recommendations suggest the supplementation of elemental calcium and cholecalciferol in all patients chronically treated with low-medium dosage of corticosteroids. 28 In case of vitamin D deficiency, higher dosage should be initially prescribed and then lowered to a standard dosage of cholecalciferol (600 – 800IU/