SLE- as a Haematological problem & the Kozhikode criteria for diagnosis

Abstract

Sasidharan PK, Arathi N, Bindiya M

Systemic Lupus Erythematosus (SLE) is a chronic recurrent multisystem autoimmune disorder, which is difficult to diagnose and there is no single diagnostic marker. The cells and tissues undergo damage mediated by tissue binding auto antibodies. At its commencement it may involve one organ alone or more than one organ concurrently. Over a time only, additional manifestations due to involvement of other organs may occur.  It is diagnosed with the help of a set of clinical and laboratory criteria. Accurate diagnosis of this disorder is important because early diagnosis and appropriate treatment reduces morbidity and mortality. This extended abstract gives some new observations on SLE, after studying more than 300 cases in a referral center and two original studies. All these were patients who came as diagnostic problems and not as established diagnosis of SLE. Diagnosis of any autoimmune disorder should be by good clinical evaluation to exclude all other causes for the presenting symptoms and looking for some supportive evidences on physical examination and laboratory evaluation and a finally prompt response and sustained remission on immuno suppressants. The observations and studies by us have confirmed that hematological manifestations are the commonest initial presentation in SLE.6 the standards widely used for diagnosis was the American College of Rheumatology (ACR) Benchmarks, which is only a classification norm and not really for diagnosis. Time required for satisfying all the 4 of the 11 criteria is variable and prolonged. Greatest cases do not satisfy all these at presentation and if one be contingent on ACR criteria for diagnosis, it takes several years to confirm the disease as SLE. If we utilize ACR criteria alone, the diagnosis of this potential life-threatening disorder would be delayed with consequent poorer outcomes. Another pitfall of the ACR criteria is that it does not give adequate weightage for hematological manifestations, in spite of the fact that hematological manifestations are the commonest; it is not represented adequately, leading to missing the diagnosis of SLE. Another point of interest is that, SLE is considered to be a rheumatologic disorder, the logic of which is questionable too. Blood and blood vessels contain more variety of antigens than all the other organs and naturally therefore the clinical manifestations should be more often hematological