Thursday, December 30, 2010

study case

Signs and Symtoms

fatigue -Frequently
fever - Occasionally
migraine-like headache - Yes
loss of appetite - Sometimes
hair loss - Yes
joint pain - Knee and Fingers
rash - No
raynaud's phenomenon (bluish discoloration fingers and toes during cold) - Yes
Ulcers inside the mouth and nose - Occasionally
low white blood cells - Yes
low blood clotting factors - Yes
chest pain aggravated by coughing, deep breathing, and certain changes in body position.-Sometimes
numbness, tingling, and weakness of the involved body parts or extremities - Yes

1 - Lupus is an autoimmune, rheumatic disease.

In lupus, the immune system of the body attacks its own cells and tissues. Specifically, the joints, skin, kidneys, lungs, heart, nervous system, and other organs of the body are affected.

2 - There are five types of lupus.

  • Systemic lupus erythematosus - affects joints and organs
  • Discoid lupus - affects the skin
  • Sub-acute cutaneous lupus erythematosus - characterized by a specific, non-scarring skin lesion
  • Drug-induced lupus - develops after a drug reaction
  • Neonatal lupus - affects newborns

3 - Ninety percent of lupus patients are women.

Lupus affects roughly 10 times as many women as men. Most often, lupus develops in people 18 to 45 years old. Though lupus is most prevalent among women, it also may affect men and children, as well as people of all ages.

4 - There are 11 American College of Rheumatology criteria for Lupus.

Lupus is differentiated from other connective tissue diseases, based on eleven criteria offered by the American College of Rheumatology for classification purposes.
  • Butterfly-shaped rash across cheeks and nose - No
  • Scaly disk-shaped rash on face, neck, ears, scalp, chest -No
  • Sunlight sensitivity - Not sure
  • Mouth sores, tongue sores, inside nose sores - Occasionally
  • Arthritis pain in joints - Occasionally at fingers and knee
  • Pain in chest and side when breathing or moving - Yes
  • Kidney problems - Not sure
  • Neurologic problems - Not sure
  • Blood problems such as anemia, low white cell count - Yes
  • Immune system malfunction - Not sure
  • Antinuclear antibodies - Yes. ANA positive titre - 1:160, ANA pattern - SPECKLED
It is recommended that if you have four or more of the eleven criteria, you should consult with a rheumatologist.
Antinuclear Antibody (ANA)

A screening test for ANA is standard in assessing SLE because it is positive in close to 100% of patients with active SLE. However, it is also positive in 95% of patients with mixed connective tissue disease, in more than 90% of patients with systemic sclerosis, in 70% of patients with primary Sjögren's syndrome, in 40-50% of patients with rheumatoid arthritis, and in 5-10% of patients with no systemic rheumatic disease. Patients with SLE tend to have high titers of ANA. False-positive results are found during chronic infectious diseases, such as subacute bacterial endocarditis, tuberculosis, hepatitis, and malaria. The sensitivity and specificity of ANA determinations depend on the technique used.

5 - Lupus diagnosis may be difficult.

Lupus is considered an unpredictable disease, with no two cases exactly the same. The unique pattern of symptoms associated with lupus has caused some to say that lupus is like a snowflake. No two are alike. There are several symptoms of lupus which mimic other rheumatic diseases (e.g., severe fatigue), making the diagnostic process difficult.

6 - Lupus treatment depends on symptoms and severity of symptoms.

Conservative treatment with NSAIDs (i.e., nonsteroidal anti-inflammatory drugs like ibuprofen) and plaquenil may be appropriate for lupus patients with non-life threatening symptoms such as joint pain, muscle pain, fatigue, and skin rashes. More aggressive treatment which may include high dose corticosteroids or immunosuppressive drugs is used when there are severe organ complications. The benefits and risks of treatment must be weighed by each patient and their doctor.

7 - Up to 1.5 million people across the nation may have lupus.

Though the Lupus Foundation of America estimates that 1.5 million Americans have lupus, the Centers for Disease Control and Prevention offer a more conservative estimate of 237,000. Approximately 70 percent of lupus cases are systemic. In 50 percent of those cases, it is a major organ which is affected.

8 - Certain races have an increased risk of developing lupus.

According to the Lupus Foundation of America, lupus is two to three times more prevalent among people of color, including African-Americans, Hispanics, Asians, and Native Americans.

9 - The majority of lupus patients lead normal lives.

With careful monitoring of lupus, and treatment adjustments as needed, most lupus patients lead normal lives. There may be some limitations and the disease may impose restrictions at times but with good disease management quality of life can be sustained. The worst adversary comes from within, when the patient loses hope, loses will, and gives in to frustration and depression.

10 - A rheumatologist is a medical doctor who specializes in treating arthritis and other rheumatic conditions, including lupus.

Your primary care doctor can refer you to a rheumatologist , or you can get an appointment through self-referral if your health insurance allows it. Evaluation by a rheumatologist is important so that a patient can develop a treatment plan.

Add Note
rash- aku rasa aku tak pernah ada butterfly rash tu.. tapi aku baru ingat aku pernah dapat skin burn teruk bila mandi kat kolam renang ke, mandi laut ke, kulit muka aku merah2 sampai bertukar kulit. tu kira rash kah? bukan kot.
pastu masa pergi rumah orang asli dulu, aku tidur dapam bus masa dalam perjalanan, tak tutup tingkap dengan langsir.. sampai2 je muka aku merah-merah sebab dapat skin burn. tu butterfly rash ke? aku tak paham ma skin rash tu macam mana.

anyway, this is only a study case. im still studying the other topics that might related to me. i'm gonna prove that he was soooo wrong. doktor kat klinik warga tu, senang-lenang je cakap aku ada sakit ni dengan konfident dan muka serius plak tu. menggigil lutut, buat aku cuak tak tentu pasal.
ini lah balasan tuhan sebab tak follow up hemato dulu. memandai-mandai lagi defaulted. padan lah muka kau wanie. tapi bagus jugak aku defaulted dulu. kalau tak, mesti aku tak tenteram nak pegi uk then jawab final exam.. ada hikmah jugak..
dulu aku pernah tulis pasal raynauld syndrome.. tak sangka ada kaitan dengan SLE jugak.. tak terpikir lansung..