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Question 10#

A 20-year-old woman has developed low-grade fever, a malar rash, and arthralgias of the hands over several months. High titers of anti-DNA antibodies are noted, and complement levels are low. The patient’s white blood cell count is 3000/µL, and platelet count is 90,000/µL. The patient is on no medications and has no signs of active infection. Which of the following statements is correct? 

A) If glomerulonephritis, severe thrombocytopenia, or hemolytic anemia develops, high-dose glucocorticoid therapy would be indicated
B) Central nervous system symptoms will occur within 10 years
C) The patient can be expected to develop Raynaud phenomenon when exposed to cold
D) Joint deformities will likely occur
E) The disease process described is an absolute contraindication to pregnancy

Correct Answer is A

Comment:

The combination of fever, malar rash, and arthritis suggests systemic lupus erythematosus (SLE), and the patient’s thrombocytopenia, leukopenia, and positive antibody to native DNA provide more than four criteria for a definitive diagnosis. Other criteria for the diagnosis of lupus include discoid rash, photosensitivity, oral ulcers, serositis, renal disorders (proteinuria or cellular casts), and neurologic disorder (seizures). High-dose corticosteroids would be indicated for severe or life-threatening complications of lupus such as described in item a. The arthritis in SLE is nondeforming. Patients with SLE have an unpredictable course. Few patients develop all signs or symptoms. Neuropsychiatric disease occurs at some time in about half of all SLE patients and Raynaud phenomenon in about 25%. Pregnancy is relatively safe in women with SLE who have controlled disease and are on less than 10 mg of prednisone.