Systemic lupus erythematosus (SLE) is a chronic, multisystem, inflammatory disorder of autoimmune etiology, occurring predominantly in young women.

Common manifestations may include arthralgias and arthritis; malar and other skin rashes; pleuritis or pericarditis; renal or CNS in ol ement; and hematologic cytopenias. !iagnosis re"uires clinical and serologic criteria. #reatment of se ere ongoing acti e disease re"uires corticosteroids, often hydro$ychloro"uine, and sometimes immunosuppressants. %f all cases, &' to (') occur in women (usually of child*+earing age). SLE is more common among +lacks and ,sians than whites. -t can affect patients of any age, including neonates. -ncreased awareness of mild forms has resulted in a worldwide rise in reported cases. -n some countries, the pre alence of SLE ri als that of .,. SLE may +e precipitated +y currently unknown en ironmental triggers that cause autoimmune reactions in genetically predisposed people. Some drugs (eg, hydrala/ine, procainamide, isonia/id ) cause a re ersi+le lupus*like syndrome. Symptoms and Signs Clinical findings ary greatly. SLE may de elop a+ruptly with fe er or insidiously o er months or years with episodes of arthralgias and malaise. 0ascular headaches, epilepsy, or psychoses may +e initial findings. 1anifestations refera+le to any organ system may appear. 2eriodic e$acer+ations (flares) may occur. 3oint manifestations4 3oint symptoms, ranging from intermittent arthralgias to acute polyarthritis, occur in a+out (') of patients and may precede other manifestations +y years. 1ost lupus polyarthritis is nondestructi e and nondeforming. 5owe er, in long*standing disease, deformities without +one erosions may de elop (eg, the metacarpophalangeal and interphalangeal 6oints may rarely de elop ulnar drift or swan*neck deformities without +ony or cartilaginous erosions 73accoud8s arthritis9). Skin and mucous mem+rane manifestations (see also ,utoimmune .heumatic !isorders4 0ariant :orms of Lupus)4 Skin lesions include malar +utterfly erythema (flat or raised) that generally spares the nasola+ial folds. #he a+sence of papules and pustules helps distinguish SLE from rosacea. , ariety of other erythematous, firm, maculopapular lesions can occur elsewhere, including e$posed areas of the face and neck, upper chest, and el+ows. Skin +listering and ulceration are rare, although recurrent ulcers on mucous mem+ranes (particularly the central portion of the hard palate near the 6unction of the hard and soft palate, the +uccal and gum mucosa, and the anterior nasal septum) are common. ;enerali/ed or focal alopecia is common during acti e phases of SLE. 2anniculitis can cause su+cutaneous nodular lesions. 0asculitic skin lesions may include mottled erythema on the palms and fingers, periungual erythema, nail* fold infarcts, urticaria, and palpa+le purpura. 2etechiae may de elop secondary to throm+ocytopenia. 2hotosensiti ity occurs in most patients. Cardiopulmonary manifestations4 Cardiopulmonary symptoms commonly include recurrent pleurisy, with or without pleural effusion. 2neumonitis is rare, although minor impairments in pulmonary function are common. Se ere pulmonary hemorrhage occasionally occurs. 2rognosis has traditionally +een poor +ut seems to +e impro ing, possi+ly +ecause of +etter early,

aggressi e, critical care. %ther complications include pulmonary em+oli, pulmonary hypertension, and shrinking lung syndrome. Cardiac complications include pericarditis (most commonly), pericardial effusion, and myocarditis. Serious, rare complications are coronary artery asculitis, al ular in ol ement, and Li+man*Sacks endocarditis. ,ccelerated atherosclerosis is an increasing cause of mor+idity and mortality. Congenital heart +lock can de elop in neonates. ,denopathy and splenic manifestations4 ;enerali/ed adenopathy is common, particularly among children, young adults, and +lacks. Splenomegaly occurs in <') of patients. #he spleen may de elop periarterial fi+rosis. Neurologic manifestations4 Neurologic symptoms can result from in ol ement of any part of the central or peripheral ner ous system or meninges. 1ild cogniti e impairment is common. #here may also +e headaches, personality changes, ischemic stroke, su+arachnoid hemorrhage, sei/ures, psychoses, organic +rain syndrome, aseptic meningitis, peripheral neuropathies, trans erse myelitis, or cere+ellar dysfunction. .enal manifestations4 .enal in ol ement can de elop at any time and may +e the only manifestation of SLE. -t may +e +enign and asymptomatic or progressi e and fatal. .enal lesions can range in se erity from a focal, usually +enign, glomerulitis to a diffuse, potentially fatal, mem+ranoproliferati e glomerulonephritis. Common manifestations include proteinuria (most often), an a+normal urinary sediment manifested +y .=C casts and leukocytes, hypertension, and edema. %+stetric manifestations4 %+stetric manifestations include early and late fetal loss. -n patients with antiphospholipid anti+odies, the risk of recurrent miscarriages is increased. 2regnancy can +e successful (see 2regnancy Complicated +y !isease4 Systemic lupus erythematosus), particularly after > to <? mo of remission, +ut SLE flares are common during pregnancy. 2regnancy should +e timed for when disease is in remission. !uring pregnancy, the patient should +e monitored closely for any disease flare or throm+otic e ents +y a multidisciplinary team that includes a rheumatologist, an o+stetrician who speciali/es in high*risk pregnancies, and a hematologist. 5ematologic manifestations4 5ematologic manifestations include anemia (often autoimmune hemolytic), leukopenia (usually lymphopenia, with @ <A'' cellsBCL,), and throm+ocytopenia (sometimes life*threatening autoimmune throm+ocytopenia). .ecurrent arterial or enous throm+osis, throm+ocytopenia, and a high pro+a+ility of o+stetric complications occur in patients with antiphospholipid anti+odies. #hrom+oses pro+a+ly account for many of the complications of SLE, including o+stetric complications. ;- manifestations4 ;- manifestations can result from +owel asculitis or impaired +owel motility. -n addition, pancreatitis can result from SLE or from its treatment with corticosteroids or a/athioprine. 1anifestations may include a+dominal pain from serositis, nausea, omiting, manifestations of +owel perforation, and pseudo*o+struction. SLE rarely causes parenchymal li er disease.

!iagnosis

Clinical criteria Cytopenias ,utoanti+odies

SLE should +e suspected in patients, particularly young women, with any of the symptoms and signs. 5owe er, early*stage SLE can mimic other connecti e (or nonconnecti e) tissue disorders, including ., if arthritic symptoms predominate. 1i$ed connecti e tissue disease can mimic SLE +ut also may in ol e features of systemic sclerosis, rheumatoid*like polyarthritis, and polymyositis or dermatomyositis. -nfections (eg, +acterial endocarditis, histoplasmosis) can mimic SLE and may de elop as a result of treatment*caused immunosuppression. !isorders such as sarcoidosis and paraneoplastic syndromes can also mimic SLE. La+oratory testing differentiates SLE from other connecti e tissue disorders. .outine testing should include the following4

,ntinuclear anti+odies (,N,) C=C Drinalysis Chemistry profile including renal and li er en/ymes

Fluorescent ANA: The fluorescent test for ANA is the best screen for SLE; positive ANA tests (usually in high titer: > 1: !" occur in > # $% &o'ever( positive ANA tests can also occur in )A( other connective tissue *isor*ers( cancers( an* even in the general population% The false+ positive rate varies fro, about -$ for ANA titers of 1:-.! to about -!$ for ANA titers of 1:/! a,ong healthy controls%

%ther ,N, and anticytoplasmic anti+odies4 #he ,N, test is ery sensiti e, +ut it is not specific for SLE; thus, e idence of other autoanti+odies is needed to esta+lish the diagnosis. #hey include .o 7SS,9, La 7SS=9, Smith 7Sm9, ri+onucleoprotein 7.N29, and dou+le*stranded !N,. .o is predominantly cytoplasmic; anti*.o anti+odies are occasionally present in ,N,*negati e SLE patients presenting with chronic cutaneous lupus. ,nti*.o is the causal anti+ody for neonatal lupus and congenital heart +lock. ,nti*Sm is highly specific for SLE +ut, like antiEdou+le* stranded !N,, is not sensiti e. ,nti*.N2 occurs in patients with SLE, mi$ed connecti e tissue disease, and occasionally other systemic autoimmune disorders and systemic sclerosis %ther +lood tests4 Leukopenia (usually lymphopenia) is common. 5emolytic anemia may occur. #hrom+ocytopenia in SLE may +e difficult or impossi+le to differentiate from idiopathic throm+ocytopenic purpura e$cept that patients ha e other features of SLE. :alse*positi e serologic tests for syphilis occur in A to <') of SLE patients. #hese test results may +e associated with the lupus anticoagulant and a prolonged 2##. ,+normal alues in one or more of these assays suggest the presence of antiphospholipid anti+odies (eg, anticardiolipin anti+odies), which should then +e measured directly +y en/yme*linked immunosor+ent assay (EL-S,).

,ntiphospholipid anti+odies are associated with arterial or enous throm+osis, throm+ocytopenia, and, during pregnancy, spontaneous a+ortion or late fetal death +ut may +e present in asymptomatic patients. %ther tests help monitor disease se erity and determine the need for treatment. Serum complement le els (CF, CG) are often depressed in acti e disease and are usually lowest in patients with acti e nephritis. ES. is ele ated fre"uently during acti e disease. C*reacti e protein le els are not necessarily ele ated. .enal in ol ement4 Screening for renal in ol ement +egins with urinalysis. .=C and H=C casts suggest acti e nephritis. Drinalysis should +e done at regular inter als, e en for patients in apparent remission, +ecause kidney disease may +e asymptomatic. .enal +iopsy is usually not necessary for diagnosis of SLE or to confirm renal in ol ement +ut is helpful in e aluating the status of renal disease (ie, acti e inflammation s postinflammatory scarring) and guide therapy. 2atients with chronic renal insufficiency and mostly sclerotic glomeruli are not likely to +enefit from aggressi e immunosuppressi e therapy. 0ariant :orms of Lupus !iscoid lupus erythematosus (!LE)4 !LE, also sometimes called chronic cutaneous lupus erythematosus, is a set of skin changes that can occur as part of lupus, with or without systemic in ol ement. Skin lesions +egin as erythematous pla"ues and progress to atrophic scars. #hey cluster in light*e$posed areas of the skin, such as the face, scalp, and ears. Dntreated, lesions e$tend and de elop central atrophy and scarring. #here may +e widespread scarring alopecia. 1ucous mem+rane in ol ement may +e prominent, especially in the mouth. 2atients presenting with typical discoid lesions should +e e aluated for SLE. ,nti+odies against dou+le*stranded !N, are almost in aria+ly a+sent in !LE. ,lthough it does not differentiate !LE from SLE, +iopsy can rule out other disorders (eg, lymphoma or sarcoidosis). =iopsy should +e done from the acti e margin of a skin lesion.
Subacute cutaneous lupus erythe,atosus (S0LE": S0LE is a variant for, of SLE in 'hich s1in involve,ent is pro,inent% 2atients 'ith S0LE *evelop e3tensive recurring rashes% Annular or papulos4ua,ous lesions ,ay *evelop on the face( ar,s( an* trun1% Lesions are usually photosensitive an* can *evelop hypopig,entation but rarely scar% Arthritis an* fatigue are co,,on in S0LE( but neurologic an* renal ,anifestations are not% 2atients ,ay be ANA+ positive or ANA+negative% 5ost have antibo*ies to )o (SSA"% 6nfants 'hose ,others have )o antibo*ies ,ay have congenital S0LE or congenital heart bloc1% S0LE shoul* be treate* si,ilarly to SLE% http:77'''%,erc1,anuals%co,7professional7,usculos1eletal8an*8connective8tissue8*isor*ers7 autoi,,une8rheu,atic8*isor*ers7syste,ic8lupus8erythe,atosus8sle%ht,l9v#!- .-

Lupus erite,atosus siste,i1 (SLE" a*alah( 1ronis ,ultisiste,( gangguan infla,asi etiologi autoi,un( ter:a*i teruta,a pa*a 'anita ,u*a% 5anifestasi u,u, ,ung1in ter,asu1 arthralgia

*an arthritis( rua, 1ulit ,alar *an lainnya( pleuritis atau peri1ar*itis( 1eterlibatan gin:al atau SS2( *an cytopenias he,atologi% ;iagnosis ,ensyarat1an beberapa 1riteria 1linis *an serologi% 2engobatan penya1it a1tif yang parah yang se*ang berlangsung ,e,butuh1an 1orti1osteroi*( sering hy*ro3ychloro4uine( *an 1a*ang+1a*ang i,unosupresan% ;ari se,ua 1asus( <! sa,pai #!$ ter:a*i pa*a 'anita (biasanya *ari usia subur"% SLE lebih u,u, *i antara orang 1ulit hita, *an orang Asia *iban*ing1an 1ulit putih% &al ini *apat ,e,pengaruhi pasien *ari segala usia( ter,asu1 neonatus% 2ening1atan 1esa*aran *ari bentu1 ringan telah ,enga1ibat1an 1enai1an seluruh *unia *ala, 1asus yang *ilapor1an% ;i beberapa negara( prevalensi SLE saingan yang *ari )A% SLE *apat *ipicu oleh pe,icu ling1ungan saat ini ti*a1 *i1etahui yang ,enyebab1an rea1si autoi,un pa*a orang geneti1 cen*erung% =eberapa obat (,isalnya( hy*rala>ine( procaina,i*e( isonia>i*" ,enyebab1an sin*ro, lupus seperti reversibel% ?e:ala *an Tan*a Te,uan 1linis sangat bervariasi% SLE *apat ber1e,bang secara tiba+tiba *engan *e,a, atau *ia,+*ia, sela,a berbulan+bulan atau bertahun+tahun *engan episo*e arthralgia *an ,alaise% Sa1it 1epala vas1ular( epilepsi( atau psi1osis ,ung1in te,uan a'al% 5anifestasi referable untu1 setiap siste, organ ,ung1in ,uncul% E1saserbasi =er1ala (flare" ,ung1in ter:a*i% 5anifestasi =ersa,a: ge:ala =ersa,a( ,ulai *ari arthralgia inter,iten 1e polyarthritis a1ut( ter:a*i pa*a se1itar #!$ *ari pasien *an *apat ,en*ahului ,anifestasi lain *engan tahun% 2olyarthritis lupus @ebanya1an ,erusa1 *an non*efor,ing% Na,un( *ala, :ang1a pan:ang penya1it( cacat tanpa erosi tulang *apat ber1e,bang (,isalnya( sen*i interphalangeal ,etacarpophalangeal *an :arang *apat ,enge,bang1an ,elayang ulnaris atau angsa+leher cacat tanpa erosi tulang atau tulang ra'an Aarthritis Baccou* sC"% @ulit *an ,anifestasi ,e,bran ,u1osa (lihat ?angguan re,ati1 :uga autoi,,une: Darian =entu1 Lupus": Lesi 1ulit ter,asu1 ,alar 1upu erite,a (*atar atau ,engang1at" yang u,u,nya su1u ca*ang lipatan nasolabial% Ti*a1 a*anya papula *an pustula ,e,bantu ,e,be*a1an SLE *ari rosacea% =erbagai erite,atosa lainnya( perusahaan( lesi ,a1ulopapular *apat ter:a*i *i te,pat lain( ter,asu1 *aerah yang ter1ena *i 'a:ah *an leher( *a*a atas( *an si1u% @ulit teri1 *an ulserasi :arang ter:a*i( ,es1ipun ul1us berulang pa*a ,e,bran ,u1osa (teruta,a bagian tengah langit+langit 1eras *i *e1at persi,pangan *ari langit+langit luna1 *an 1eras( ,u1osa bu1al *an gusi( *an septu, hi*ung anterior" yang u,u,% ?enerali>e* atau focal alopecia u,u, sela,a fase a1tif SLE% 2anniculitis *apat ,enyebab1an lesi no*ular sub1utan% Lesi 1ulit vas1ulitis ,ung1in ter,asu1 erite,a berbinti1+binti1 *i telapa1 tangan *an :ari+:ari( erite,a periungual( 1u1u+1ali lipat infar1( urti1aria( *an purpura teraba% 2etechiae *apat ,enge,bang1an se1un*er untu1 tro,bositopenia% Fotosensitifitas ter:a*i pa*a 1ebanya1an pasien% 5anifestasi car*iopul,onary: ?e:ala u,u,nya ,eliputi 0ar*iopul,onary pleurisy berulang( *engan atau tanpa efusi pleura% 2neu,onitis :arang( ,es1ipun gangguan 1ecil *ala, fungsi paru yang u,u,% 2er*arahan paru yang parah 1a*ang+1a*ang ter:a*i% 2rognosis secara tra*isional ,is1in tetapi ta,pa1nya a1an ,e,bai1( ,ung1in 1arena lebih *ini( pera'atan agresif( 1ritis% @o,pli1asi lainnya ter,asu1 e,boli paru( hipertensi pul,onal( *an sin*ro, paru ,enyusut% @o,pli1asi :antung ter,asu1 peri1ar*itis (paling sering"( efusi peri1ar*ial( *an

,io1ar*itis% Serius( 1o,pli1asi lang1a arteri 1oroner vas1ulitis( 1eterlibatan 1atup( *an Lib,an+ Sac1s en*ocar*itis% Ateros1lerosis *ipercepat ,erupa1an penyebab ,ening1atnya ,orbi*itas *an ,ortalitas% =lo1 :antung 1ongenital *apat ber1e,bang pa*a neonatus% A*enopati *an ,anifestasi li,pa: a*enopati ?enerali>e* a*alah u,u,( teruta,a *i 1alangan ana1+ana1( orang *e'asa ,u*a( *an hita,% Spleno,egali ter:a*i pa*a 1!$ pasien% Li,pa *apat ,enge,bang1an fibrosis periarterial% Neurologis ,anifestasi: neurologis ge:ala *apat hasil *ari 1eterlibatan setiap bagian *ari siste, saraf pusat atau perifer atau ,eninges% )ingan penurunan 1ognitif u,u,% A*a :uga ,ung1in sa1it 1epala( perubahan 1epriba*ian( stro1e is1e,i1( per*arahan subarachnoi*( 1e:ang( psi1osis( sin*ro,a ota1 organi1( ,eningitis asepti1( neuropati perifer( ,yelitis ,elintang( atau *isfungsi cerebellar% 5anifestasi gin:al: @eterlibatan gin:al *apat ber1e,bang setiap saat *an ,ung1in satu+satunya ,anifestasi *ari SLE% 6ni ,ung1in :ina1 *an tanpa ge:ala atau progresif *an fatal% Lesi gin:al *apat ber1isar 1eparahan *ari glo,erulitis( fo1us biasanya :ina1( *engan glo,erulonefritis( ,enyebar berpotensi fatal( ,e,branoproliferatif% 5anifestasi u,u, ,eliputi proteinuria (paling sering"( suatu se*i,en urin yang abnor,al *i,anifestasi1an oleh gips )=0 *an leu1osit( hipertensi( *an e*e,a% @ebi*anan 5anifestasi: Ebstetri ,anifestasi ter,asu1 1ehilangan :anin a'al *an a1hir% 2a*a pasien *engan antibo*i antifosfolipi*( risi1o 1eguguran berulang ,ening1at% @eha,ilan bisa su1ses (lihat @eha,ilan 0o,plicate* oleh 2enya1it: lupus erite,atosus siste,i1"( teruta,a setelah F sa,pai 1. bulan re,isi( na,un flare SLE yang u,u, sela,a 1eha,ilan% @eha,ilan harus *iberi batas 'a1tu untu1 1eti1a penya1it *ala, penga,punan% Sela,a 1eha,ilan( pasien harus *ipantau 1etat untu1 setiap flare penya1it atau 1e:a*ian tro,boti1 oleh ti, ,ulti*isiplin yang ,enca1up rheu,atologist( seorang *o1ter 1an*ungan yang ,eng1husus1an *iri *ala, 1eha,ilan berisi1o tinggi( *an he,atologi% 5anifestasi he,atologi: ,anifestasi he,atologi ter,asu1 ane,ia (sering he,oliti1 autoi,un"( leu1openia (biasanya li,fopenia( *engan G1H!! sel 7 uL("( *an tro,bositopenia (1a*ang+1a*ang ,enganca, nya'a tro,bositopenia autoi,un"% Tro,bosis arteri atau vena yang berulang( tro,bositopenia( *an probabilitas tinggi 1o,pli1asi obstetri ter:a*i pa*a pasien *engan antibo*i antifosfolipi*% Tro,bosis ,ung1in ,en:elas1an banya1 1o,pli1asi *ari SLE( ter,asu1 1o,pli1asi 1ebi*anan% ?6 ,anifestasi: ?6 ,anifestasi *apat ter:a*i a1ibat vas1ulitis usus atau ,otilitas usus terganggu% Selain itu( pan1reatitis *apat ter:a*i a1ibat SLE atau *ari pengobatan *engan 1orti1osteroi* atau a>athioprine% 5anifestasi ,ung1in ter,asu1 sa1it perut *ari serositis( ,ual( ,untah( ,anifestasi *ari perforasi usus( *an pseu*o+obstru1si% SLE :arang ,enyebab1an penya1it hati paren1i, ;iagnosa I @linis @riteria I Sitopenia I Autoantibo*i SLE harus *icurigai pa*a pasien( 1hususnya pere,puan ,u*a( *engan salah satu ge:ala *an tan*a+tan*a% Na,un( tahap a'al SLE *apat ,eniru i1at lainnya (atau nonconnective" gangguan :aringan( ter,asu1 )A :i1a ge:ala re,ati1 ,en*o,inasi% 2enya1it :aringan i1at ca,puran *apat ,eniru SLE tetapi :uga *apat ,elibat1an fitur sclerosis siste,i1( arthritis seperti polyarthritis( *an poly,yositis atau *er,ato,yositis% 6nfe1si (,isalnya( en*o1ar*itis histoplas,osis( ba1teri"

*apat ,eniru SLE *an *apat ber1e,bang sebagai a1ibat *ari pengobatan ,enyebab1an i,unosupresi% ?angguan seperti sar1oi*osis *an sin*ro, paraneoplastic :uga *apat ,eniru SLE% 2engu:ian laboratoriu, ,e,be*a1an SLE *ari gangguan :aringan i1at% 2engu:ian rutin harus ,enca1up sebagai beri1ut: I Antinuclear antibo*i (ANA" I 0=0 I Jrinalisis I @i,ia profil ter,asu1 en>i, gin:al *an hati Fluorescent ANA: Tes fluorescent untu1 ANA a*alah layar terbai1 untu1 SLE; positif ANA tes (biasanya *ala, titer tinggi:> 1: !" ter:a*i pa*a> # $% Na,un( positif ANA tes :uga bisa ter:a*i *i )A( gangguan :aringan i1at lainnya( 1an1er( *an bah1an pa*a populasi u,u,% Ting1at positif+ palsu bervariasi *ari se1itar -$ untu1 titer ANA *ari 1:-.! ,en:a*i se1itar -!$ untu1 titer ANA 1:/! 1elo,po1 1ontrol yang sehat% Lainnya ANA *an antibo*i anticytoplas,ic: Tes ANA sangat sensitif( tetapi ti*a1 spesifi1 untu1 SLE( *engan *e,i1ian( bu1ti autoantibo*i lainnya *iperlu1an untu1 ,enega11an *iagnosis% 5ere1a ter,asu1 )o ASSAC( La ASS=C( S,ith AS,C( ribonucleoprotein A)N2C( *an *ouble+ stran*e* ;NA% )o *i*o,inasi sitoplas,a( anti+)o antibo*i 1a*ang+1a*ang ha*ir *i ANA+negatif pasien SLE ,enya:i1an *engan lupus 1ulit 1ronis% Anti+)o a*alah antibo*i 1ausal untu1 lupus neonatal *an blo1 :antung ba'aan% Anti+S, sangat spesifi1 untu1 SLE tetapi( seperti anti+;NA beruntai gan*a( ti*a1 sensitif% Anti+)N2 ter:a*i pa*a pasien *engan SLE( penya1it :aringan i1at ca,puran( *an 1a*ang+1a*ang gangguan autoi,un siste,i1 *an sclerosis siste,i1 Tes *arah lainnya: Leu1openia (biasanya li,fopenia" a*alah u,u,% Ane,ia he,oliti1 *apat ter:a*i% Tro,bositopenia pa*a SLE ,ung1in sulit atau ti*a1 ,ung1in untu1 ,e,be*a1an *ari i*iopathic thro,bocytopenic purpura 1ecuali bah'a pasien ,e,ili1i fitur lain *ari SLE% 2ositif palsu tes serologis untu1 sifilis ter:a*i pa*a H sa,pai 1!$ *ari pasien SLE% &asil pengu:ian *apat *i1ait1an *engan anti1oagulan lupus *an 2TT ber1epan:angan% Nilai abnor,al pa*a satu atau lebih *ari tes ,enun:u11an a*anya antibo*i antifosfolipi* (,isalnya( antibo*i anticar*iolipin"( yang 1e,u*ian harus *iu1ur secara langsung oleh en>i,+lin1e* i,,unosorbent assay (EL6SA"% Antibo*i antifosfolipi* yang berhubungan *engan tro,bosis arteri atau vena( tro,bositopenia( *an( sela,a 1eha,ilan( aborsi spontan atau 1e,atian :anin terla,bat tapi ,ung1in a*a pa*a pasien tanpa ge:ala% Tes+tes lain ,e,bantu 1eparahan penya1it ,onitor *an ,enentu1an 1ebutuhan untu1 pengobatan% Ting1at 1o,ple,en seru, (0-( 0/" sering terte1an pa*a penya1it a1tif *an biasanya teren*ah pa*a pasien *engan nefritis a1tif% ES) ,ening1at sering sela,a penya1it a1tif% 0+rea1tif ting1at protein ti*a1 selalu ,ening1at% @eterlibatan gin:al: S1rining untu1 1eterlibatan gin:al *i,ulai *engan urinalisis% )=0 *an K=0 gips ,enun:u11an nefritis a1tif% Jrinalisis harus *ila1u1an secara ber1ala( bah1an untu1 pasien *ala, re,isi :elas( 1arena penya1it gin:al ,ung1in tanpa ge:ala% =iopsi gin:al biasanya ti*a1 *iperlu1an untu1 *iagnosis SLE atau ,eng1onfir,asi 1eterlibatan gin:al tetapi ,e,bantu *ala, ,engevaluasi status penya1it gin:al (,isalnya( a1tif pera*angan vs postinfla,,atory :aringan parut" *an terapi pan*uan% 2asien *engan insufisiensi gin:al 1ronis *an glo,eruli sebagian besar s1leroti1 ti*a1 ,ung1in ,e,peroleh ,anfaat *ari terapi i,unosupresif agresif% Darian =entu1 Lupus

;iscoi* lupus erythe,atosus (;LE": ;LE( :uga 1a*ang+1a*ang *isebut lupus erite,atosus 1ronis 1ulit( a*alah seperang1at perubahan 1ulit yang *apat ter:a*i sebagai bagian *ari lupus( *engan atau tanpa 1eterlibatan siste,i1% Lesi 1ulit *i,ulai sebagai pla1 erite,atosa *an 1e,a:uan untu1 be1as lu1a atrofi1% 5ere1a 1laster *ala, cahaya yang terpa:an area 1ulit( seperti 'a:ah( 1ulit 1epala( *an telinga% Ti*a1 *iobati( lesi ,e,perluas *an ,enge,bang1an atrofi pusat *an :aringan parut% 5ung1in a*a :aringan parut alopecia ,eluas% @eterlibatan ,e,bran ,u1osa ,ung1in ,enon:ol( teruta,a *i ,ulut% 2asien *engan lesi *is1oi* yang 1has harus *ievaluasi untu1 SLE% Antibo*i terha*ap ;NA beruntai gan*a yang ha,pir selalu a*a *i ;LE% 5es1ipun ti*a1 ,e,be*a1an ;LE *ari SLE( biopsi *apat ,enying1ir1an gangguan lain (,isalnya( li,fo,a atau sar1oi*osis"% =iopsi harus *ila1u1an *ari ,argin a1tif lesi 1ulit% Suba1ut lupus erythe,atosus 1ulit (S0LE": S0LE ,erupa1an bentu1 varian *ari SLE *i ,ana 1eterlibatan 1ulit ,enon:ol% 2asien *engan S0LE ,enge,bang1an rua, berulang yang luas% Lesi annular atau papulos4ua,ous ,ung1in ber1e,bang pa*a 'a:ah( lengan( *an batang% Lesi biasanya fotosensitif *an *apat ,enge,bang1an hipopig,entasi tapi :arang be1as lu1a% Arthritis *an 1elelahan yang u,u, *i S0LE( na,un ,anifestasi neurologis *an gin:al ti*a1% 2asien ,ung1in ANA+positif atau negatif+ANA% @ebanya1an ,e,ili1i antibo*i terha*ap )o (SSA"% =ayi yang ibunya ,e,ili1i antibo*i )o ,ung1in ,e,ili1i S0LE ba'aan atau blo1 :antung ba'aan% S0LE harus *iperla1u1an sa,a *engan SLE%