- TEENAGE GROWING PAINS
Growing pains is a label widely used for joint
pains in teenagers and seems to cover a spectrum
of rheumatology from arthritis variants through
to lupus.
It is not uncommon for patients to give a history
going back to their teens.
Usually considered "benign" or
"idiopathic", it is often sufficiently
severe for the child to be taken to the doctor.
- TEENAGE MIGRAINE
Headache, cluster headache and migraine can be
encountered and a strong history of teenage
migraine may be of lupus significance, either at
that time or subsequently.
Possibly, this symptom is more clearly associated
with the antiphospholipid syndrome.
- TEENAGE GLANDULAR FEVER
Prolonged teenage glandular fever is a label
which crops up time and time again in lupus
patients and prolonged periods off school in many
SLE patients is a recurrent theme.
- SEVERE REACTION TO
INSECT BITES
This is a feature of so many lupus patients.
Not only are they susceptible to insect bites but
often reactions are severe and prolonged.
The skin is a major organ affected by lupus. It
would be surprising if hypersensitivity to insect
bites were not an important phenomenon in lupus.
- RECURRENT MISCARRIAGES
Lupus itself seems not to be a cause of recurrent
miscarriage but where the antiphospholipid
syndrome (APS) is present, recurrent spontaneous
fetal loss can be significant.
This an indicator of those lupus patients with
the antiphospholipid or Hughes' Syndrome.
- PRE-MENSTRUAL
EXACERBATIONS
Although difficult to quantify, it is believed
that significant pre-menstrual disease flare is
sufficiently prominent in lupus to be included in
this list.
All rheumatic diseases are clinically influenced
by the menstrual cycle and/or hormonal
fluctuations.
- SEPTRIM (and
SULPHONAMIDE) ALLERGY
Adverse reactions to these drugs is quite common
in lupus and the clinical onset of the disease
may have coincided with the use of either of
these drugs.
- AGORAPHOBIA
Agoraphobia or claustrophobia are often present
at a time when lupus disease is active.
A history of these conditions can be protracted,
lasting for months or even years.
The prevalence of central nervous system disease
in lupus varies, but with modern recognition of
the diversity of the CNS manifestations of lupus,
it is hard not to consider such histories as
"pre-lupus".
- FINGER FLEXOR TENDONITIS
Arthralgia and tenosynovitis are common features
in lupus and although not specific, the finding
of mild to moderate ten-finger flexor synovitis
is a useful pointer in the presence of other
lupus features.
It is subtly yet significantly different in
pattern from other arthritic diseases.
- FAMILY HISTORY OF
AUTOIMMUNE ILLNESS
As the genetics and statistics of the various
autoimmune diseases become better defined, the
strength of a particular family history will
become more precise.
The family history is important, as lupus is
genetically determined.
This is where clinical, as opposed to scientific,
experience comes into play.
- DRY SHIRMER'S TEST
A 'bone dry' Shirmer's test (levels of eye
moisture) points towards one of the autoimmune
diseases and in the patient with vague or
nonspecific symptoms is worth its weight in gold.
See Sjogrens
for symptomatic treatments if testing is
positive..
- BORDERLINE C4
Genetic complement deficiencies have been known
to be associated with lupus for over three
decades and in the diagnostically difficult
patient, especially where a family history is
present, repeated borderline C4 levels can be
significant indicators.
This is worth consideration in the diagnostic
jigsaw.
- NORMAL CRP WITH RAISED
ESR
An important diagnostic aid.
The rise in CRP which occurs in infection, is
sufficiently useful to make CRP one of the first
line tests in a febrile lupus patient.
A very low CRP in an otherwise inflammatory
situation is strongly supportive of lupus or
primary Sjogren's syndrome.
LYMPHOPENIA
In the patient with non-specific complaints and
unremarkable blood tests, a borderline or low
lymph count can be overlooked.
It is common in lupus and is certainly worth
inclusion among the minor criteria expecially in
the patient with very non-specific complaints and
essentially unremarkable blood tests.
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