java library barcode reader 11 Frequency of laboratory abnormalities in systemic lupus erythematosus in Objective-C

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Table 20 11 Frequency of laboratory abnormalities in systemic lupus erythematosus
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Anemia Leukopenia Thrombocytopenia Biologic false-positive tests for syphilis Antiphospholipid antibodies Lupus anticoagulant Anti-cardiolipin antibody Direct Coombs-positive Proteinuria Hematuria Hypocomplementemia ANA Anti-native DNA Anti-Sm 7% 25% 30% 30% 30% 60% 95 100% 50% 20% 60% 45% 30% 25%
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ANA, antinuclear antibody; Anti-Sm, anti-Smith antibody Modified and reproduced, with permission, from Hochberg MC et al Systemic lupus erythematosus: a review of clinicolaboratory features and immunologic matches in 150 patients with emphasis on demographic subsets Medicine (Baltimore) 1985 Sep;64(5):285 95
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finding suggestive of disease activity often returns toward normal in remission Anti-double-stranded DNA antibody levels also correlate with disease activity in some patients; anti-Sm levels do not Three types of antiphospholipid antibodies occur (Table 20 11) The first causes the biologic false-positive tests for syphilis; the second is the lupus anticoagulant, which despite its name is a risk factor for venous and arterial thrombosis and miscarriage It is most commonly identified by prolongation of the activated partial thromboplastin time, an in vitro phenomenon related to antibody reacting to phospholipid in the test materials Anticardiolipin antibodies are the third type of antiphospholipid antibodies In many cases, the anticardiolipin antibody appears to be directed at a serum cofactor ( 2glycoprotein-I) rather than at phospholipid itself Abnormality of urinary sediment is almost always found in association with renal lesions Showers of red blood cells, with or without casts, and proteinuria (varying from mild to nephrotic range) are frequent during exacerbation of the disease; these usually abate with remission
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Patient education and emotional support, as described for rheumatoid arthritis, are especially important for patients with lupus Since the various manifestations of SLE affect prognosis differently and since SLE activity often waxes and wanes, drug therapy both the choice of agents and the intensity of their use must be tailored to match disease severity Patients with photosensitivity should be cautioned against sun exposure and should apply a protective lotion to the skin while out of doors Skin lesions often respond to the
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The prognosis for patients with systemic lupus appears to be considerably better than older reports implied From both community settings and university centers, 10-year survival rates exceeding 85% are routine In most patients, the illness pursues a relapsing and remitting course Corticosteroids, often needed in doses of 40 mg/d or more during severe flares,
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can usually be tapered to low doses (5 10 mg/d) when the disease is inactive However, there are some in whom the disease pursues a virulent course, leading to serious impairment of vital structures such as lung, heart, brain, or kidneys, and the disease may lead to death With improved control of lupus activity and with increasing use of corticosteroids and immunosuppressive drugs, the mortality and morbidity patterns in lupus have changed Mortality in SLE shows a bimodal pattern In the early years after diagnosis, infections especially with opportunistic organisms are the leading cause of death, followed by active SLE, chiefly due to renal or central nervous system disease In later years, accelerated atherosclerosis, attributed in part to corticosteroid use, becomes a major cause of death Indeed, the incidence of myocardial infarction is five times higher in persons with SLE than in the general population Therefore, it is especially important for SLE patients to avoid smoking and to minimize other conventional risk factors for atherosclerosis (eg, hypercholesterolemia, hypertension, obesity, and inactivity) Patients with SLE should receive influenza vaccination every year and pneumococcal vaccination every 5 years Since some reports indicate that SLE patients have a higher risk of developing malignancy, preventive cancer screening recommendations should be followed assiduously With more patients living longer, it has become evident that avascular necrosis of bone, affecting most commonly the hips and knees, is responsible for substantial morbidity Still, the outlook for most patients with SLE has become increasingly favorable
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