Rheumatology
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Antiphospholipid Antibody Syndrome (APLS)
- 20% of SLE patients will also have APLS and be prone to clotting and strokes
- If rapid organ failure from multiple thromboses (including strokes) then is considered catastrophic APLS
- Lab testing: at Penn one order for all combined (anti-cardiolipin antibody, dilute Russell viper venom time aka DRVVT, lupus anticoagulant)
- Many of these patients are on Lovenox (enoxaparin) or warfarin for thrombosis prophylaxis
- Allopurinol is usually held in an acute flare and started afterward for long-term uric acid/urate-lowering therapy
- Treatment: high dose NSAID treatment or more commonly colchicine (for normal kidneys can give 1.2mg on day one followed by 0.6mg one hour later then 0.6mg daily until symptoms resolve), can also give short course of tapering prednisone (dosing is stylist) as monotherapy but steroid treatment associated with higher risk of rebound flares
- Symptoms/signs: malar rash on face, discoid rash on rest of skin, pleurisy or pericarditis, oral ulcers, arthritis, photosensitive rash, hemolytic anemia, thrombocytopenia, leukopenia, lymphopenia, AKI, proteinuria, seizures, lupus cerebritis
- Labs: ANA for general diagnosis (sensitivity 99%, specificity 49%) but can be seronegative, anti-double stranded DNA (for acute flare), anti-Smith antibody, often false positive with syphilis RPR test
- Treatment: usually admitted for IV steroids, continue home Plaquenil (hydroxychloroquine), and consider non-steroidal disease modifying agents such as cyclophosphamide (Cytoxan), methotrexate, azathioprine
- 20% of SLE patients will also have APLS (antiphospholipid antibody syndrome) and be prone to clotting and strokes