|
Lupus-Selbsthilfe |
|
Diagnostik des LE SLE Neue SLICC- Klassifikationskriterien für den systemischen Lupus Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, Bruce IN, Isenberg D, Wallace DJ, Nived O, Sturfelt G, Ramsey-Goldman R, Bae SC, Hanly JG, Sánchez-Guerrero J, Clarke A, Aranow C, Manzi S, Urowitz M, Gladman D, Kalunian K, Costner M, Werth VP, Zoma A, Bernatsky S, Ruiz-Irastorza G, Khamashta MA, Jacobsen S, Buyon JP, Maddison P, Dooley MA, van Vollenhoven RF, Ginzler E, Stoll T, Peschken C, Jorizzo JL, Callen JP, Lim SS, Fessler BJ, Inanc M, Kamen DL, Rahman A, Steinsson K, Franks AG Jr, Sigler L, Hameed S, Fang H, Pham N, Brey R, Weisman MH, McGwin G Jr, Magder LS. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012 Aug;64(8):2677-86 http://onlinelibrary.wiley.com/doi/10.1002/art.34473/pdf Clinical and immunologic criteria used in the SLICC classification system: Clinical criteria: 1. Acute cutaneous lupus, including: Lupus malar rash (do not count if malar discoid) Bullous lupus Toxic epidermal necrolysis variant of SLE Maculopapular lupus rash Photosensitive lupus rash in the absence of dermatomyositis OR subacute cutaneous lupus (nonindurated psoriaform and/or annular polycyclic lesions that resolve without scarring, although occasionally with postinflammatory dyspigmentation or telangiectasias) 2. Chronic cutaneous lupus, including: Classic discoid rash Localized (above the neck) Generalized (above and below the neck) Hypertrophic (verrucous) lupus Lupus panniculitis (profundus) Mucosal lupus Lupus erythematosus tumidus Chillblains lupus Discoid lupus/lichen planus overlap 3. Oral ulcers Palate Buccal Tongue OR nasal ulcers in the absence of other causes, such as vasculitis, Behçet's disease, infection (herpesvirus), inflammatory bowel disease, reactive arthritis, and acidic foods 4. Nonscarring alopecia (diffuse thinning or hair fragility with visible broken hairs) in the absence of other causes such as alopecia areata, drugs, iron deficiency, and androgenic alopecia 5. Synovitis involving 2 or more joints, characterized by swelling or effusion OR tenderness in 2 or more joints and at least 30 minutes of morning stiffness 6. Serositis Typical pleurisy for more than 1 day OR pleural effusions OR pleural rub Typical pericardial pain (pain with recumbency improved by sitting forward) for more than 1 day OR pericardial effusion OR pericardial rub OR pericarditis by electrocardiography in the absence of other causes, such as infection, uremia, and Dressler's pericarditis 7. Renal Urine protein-to-creatinine ratio (or 24-hour urine protein) representing 500 mg protein/24 hours OR red blood cell casts 8. Neurologic Seizures Psychosis Mononeuritis multiplex in the absence of other known causes such as primary vasculitis Myelitis Peripheral or cranial neuropathy in the absence of other known causes such as primary vasculitis, infection, and diabetes mellitus Acute confusional state in the absence of other causes, including toxic/metabolic, uremia, drugs 9. Hemolytic anemia 10. Leukopenia (< 4,000/mm³ at least once) in the absence of other known causes such as Felty's syndrome, drugs, and portal hypertension OR Lymphopenia (< 1,000/mm³ at least once) in the absence of other known causes such as corticosteroids, drugs, and infection 11. Thrombocytopenia (< 100,000/mm³) at least once in the absence of other known causes such as drugs, portal hypertension, and thrombotic thrombocytopenic purpura Immunologic criteria: 1. ANA level above laboratory reference range 2. Anti-dsDNA antibody level above laboratory reference range (or > 2-fold the reference range if tested by ELISA) 3. Anti-Sm: presence of antibody to Sm nuclear antigen 4. Antiphospholipid antibody positivity as determined by any of the following: Positive test result for lupus anticoagulant False-positive test result for rapid plasma reagin Medium- or high-titer anticardiolipin antibody level (IgA, IgG, or IgM) Positive test result for anti-ß2-glycoprotein I (IgA, IgG, or IgM) 5. Low complement Low C3 Low C4 Low CH50 6. Direct Coombs' test in the absence of hemolytic anemia According to the SLICC rule for the classification of SLE, the patient must satisfy at least 4 criteria, including at least one clinical criterion and one immunologic criterion OR the patient must have biopsyproven lupus nephritis in the presence of antinuclear antibodies or anti-double-stranded DNA antibodies. Criteria are cumulative and need not be present concurrently. SLICC = Systemic Lupus International Collaborating Clinics SLE = systemic lupus erythematosus ANA = antinuclear antibody anti-dsDNA = anti-double-stranded DNA ELISA = enzyme-linked immunosorbent assay Kommentar: Neu ist die differenzierte Beschreibung der verschiedenen Formen des Hautlupus und die genauere Fassung der Laborkriterien. Von den nun 17 Kriterien müssen mindestens 4 erfüllt sein, die nicht gleichzeitig vorliegen müssen. Die SLICC-Kriterien beschreiben nicht das gesamte Krankheitsbild des SLE, sondern greifen lediglich bestimmte Beschwerden und Befunde heraus, die in ihrer Kombination typischerweise bei SLE und weniger bei anderen Erkrankungen auftreten. Darüberhinaus gibt es bei Lupus erythematodes ein großes Spektrum von Krankheitserscheinungen, die in den SLICC-Kriterien nicht erwähnt werden. Beispielsweise haben viele SLE-Betroffene Beschwerden im Sinne eines Raynaud-Syndroms, dies kommt jedoch auch bei der Sklerodermie oder dem Sjögren-Syndrom recht häufig vor. Genauso gut können Haarausfall oder Durchfall auch bei vielen anderen Krankheiten auftreten. Damit die Diagnose SLE gestellt werden kann, müssen mindestens vier dieser Kriterien erfüllt sein. Die Beschwerden und Befunde müssen nicht gleichzeitig vorliegen, sondern können auch im Lauf der Zeit nacheinander auftreten. Andere Formulierungen für die Diagnose "SLE" lauten zum Beispiel: "Kollagenose (LED)", "LED" oder "syst. Lupus erythematodes". "LED" ist die Abkürzung für die lateinische Bezeichnung "Lupus erythematosus disseminatus", was das Gleiche bedeutet. Rheumafaktoren haben für die Diagnose des LE keine besondere Bedeutung. Hinweis: Die SLICC-Kriterien werden im Patientenratgeber "Lupus - die Krankheit als Herausforderung und Chance, ein Beitrag zur Gender Medizin", von Dorothea Maxin, Darmstadt, Verlag für neue Medizin, 2012, näher besprochen http://www.patientinnenberatung.de/ratgeber.htm. |
