MEDICAL INSIDER
DR CORA LIM
FOR JUNE 4 2023
Applied Rheumatology Made Simple (A.R.M.S.)
(Part 10 )
Here are some questions we tackle in this issue:
What are we supposed to consider about mild SLE? The answers
are: Diagnosed or highly suspected SLE; Clinically stable
disease; Not life-threatening; With normal & stable body systems
like the kidneys, skin, joints, hematologic, lungs, heart, Gl, CNS
and No significant toxicities from SLE therapies
What are some of the suggested ways to treat mild SLE? The
answers are: Patient education, Analgesics as needed, NSAIDs
as needed (caution on side effects), Topical steroid and
sunscreens, Adequate rest – especially during disease flare, and
Low-dose glucocorticoid.
What are some of the reasons we have to refer the patient with
mild SLE to a rheumatologist? The answers are: To confirm the
diagnosis or consider other possibilities; To assess disease
activity and severity; To provide general disease management; To
manage uncontrolled or life-threatening disease; To
manage/prevent treatment toxicities; Other special circumstances
e.g. antiphospholid syndrome, pregnancy, surgery
What are other suggested SLE “HELP-LINES”” The answers are:
Internal Machine, Nephrology, Dermatology, Hematology,
Neurology, Cardiology, Pulmonology, Lupus support groups
What are some warning signs of a serious rheumatic disease?
The answers are: Persistent, worsening pains; Pains unrelieved
by regular intake of NSAIDs or other potent analgesics; “Nerve
pains”, “vascular pains”, “bone pains”; Accompanying fever;
weight loss, pallor etc.
What are some of the laboratory clues to a serious rheumatic
disorder? The answers are: Anemia, thrombocytopenia,
leucocytosis, leucopenia; Elevated ESR (corrected for age and
anemia); Active urine sediment; Abnormal radiographs e.g.
pulmonary mass, lytic/blastic lesions on skeletal x-rays; and
elevated alkaline phosphatase, acid phosphatase, creatinine.
What are the mimics of rheumatic diseases-1? The answers are:
Cardiovascular disease e.g. myxomas; Vasculitis; Drug effects
e.g. retinoids, ergot derivatives; Spondyloarthropathies –
Raynaud’s phenomenon; Endocrine disorders e.g. thyroiditis,
hypothyroidism- Vasculitis – Polymyositis – Carpal tunnel
syndrome; Gastrointestinal disease e.g. celiac disease –
Polyarthritis
What are the mimics of rheumatic diseases-II? The answers are :
Malignancies (Monoarthritis, Polyarthntis, Vasculitis); Cholesterol
emboli (Vasculitis); Infectious disease e.g. parvovirus B19,
leprosy (Rheumatoid arthritis, Systemic lupus erythematosus,
Vasculitis) – To be continued