Paediatric- History taking & Physical examination of Childhood-onset systemic lupus erythematosus (cSLE)/Juvenile SLE (jSLE)

Paediatric- History taking & Physical examination of Childhood-onset systemic lupus erythematosus (cSLE)/Juvenile SLE (jSLE)Created OnApril 22, 2020Last Updated OnApril 22, 2020byadmin You are here: Main Clinical Examination Paediatric- History taking & Physical examination of Childhood-onset systemic lupus erythematosus (cSLE)/Juvenile SLE (jSLE) < All Topics Table of Contents Clinical manifestation: Constitutional Fever, loss of appetite, loss of weight, lethargy, lymphadenopathy Mucocutaneous Malar rash (60% jSLE), oral/nasal erythema and ulcers, maculopapular, vasculitic rash (petechiae, purpura, nodules, ulcers), photosensitivity, discoid rash (10%), diffuse alopecia, Raynaud’s phenomenon, bullous, livedo reticularis Cardiac Chest pain, pericarditis, pericardial effusion, myocarditis with heart failure, Libmann-Sacks endocarditis. Respiratory Shortness of breath, decrease effort tolerance, interstitial lung disease, pleuritis and pleural effusion, pulmonary haemorrhage Gastrointestinal tract Hepatosplenomegaly, hepatitis (25%), diffuse abdominal pain, serositis, diarrhaea, pancreatitis, gastrointestinal tract vasculitis + bowel perforation Renal Nephrotic syndrome, proteinuria, haematuria, hypertension, renal impairment, acute renal failure Lupus nephritis is classified based on histopathology: Class I – minimal mesangial glomerulonephritis Class II – mesangial proliferative lupus nephritis Class III – focal proliferative nephritis Class IV – diffuse proliferative nephritis Class V – membranous nephritis Class VI – glomerulosclerosis Musculoskeletal Arthralgia, arthritis (usually non-erosive and non-deforming), myalgia, myositis, tenosynovitis Neuropsychiatric Headache, migraine, mood disorder, cognitive impairment, seizures, stroke, psychosis (visual > auditory hallucinations), acute confusional state, cranial and peripheral neuropathies Haematological Autoimmune hemolytic anemia, leucopenia, lymphopenia, thrombocytopenia, Coombs positivity, Thrombotic thrombocytopenic purpura, antiphospholipid antibodies Ocular Uveitis, optic neuritis, vaso-occlusive retinal vasculitis, retinopathy (cottonwool spots), episcleritis History taking: Ask about patient’s information – name, age, gender, ancestry (to explore the non-modifiable risk factors) Ask about chief complaints and relevant history of presenting illness Common presentations: Prolonged fever and malaise with evidence of multisystem involvement Fatigue, joint pain, rash Acute symptoms such as memory loss, psychosis, coughing up blood, neurological manifestations due to transverse myelitis, oedema of the lower extremities, headache and painful mouth sores Ask about clinical manifestations of SLE: Constitutional – fever, loss of appetite, loss of weight, lethargy, swollen lymph nodes Mucocutaneous – rash, photosensitivity, dry eyes or dry mouth, nose bleeds or nasal sores, oral ulcers, colour changes from white-blue-red in hands or feet (Raynaud’s phenomenon), hair thinning or falling out (alopecia) Cardiorespiratory – chest pain, shortness of breath, hemoptysis, coughing, exercise intolerance Gastrointestinal – stomach pain (hepatitis, GIT vasculitis, serositis, bowel perforation), diarrhoea, abdominal distension (hepatosplenomegaly) , steatorrhea (pancreatitis) Genitourinary – haematuria or tea-coloured urine, foamy urine (proteinuria), oedema and puffy eyes especially in the morning (nephrotic syndrome), headache or visual changes (hypertensive emergency) Central nervous system – headaches, poor school performance, depression, difficulty concentrating, memory loss, hallucination, seizure Musculoskeletal – joint pain, swelling, stiffness, gelling, muscle pain or weakness Haematological – cold peripheries, palpitation, dizziness and shortness of breath (anaemia), easy bruising or bleeding tendency (thrombocytopenia) Ocular – red eye, photophobia, reduced vision, ocular pain, increased lacrimation (uveitis) If the patient has previously been diagnosed with SLE, ask about: When and how the patient was diagnosed?...

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