Systemic Lupus Erythematosus (SLE or Lupus) is a difficult disease to diagnose.  Because the signs/symptoms can occur in a wide variety of organ systems, it is difficult to pinpoint the diagnosis of SLE initially.  The diagnosis of SLE is based on clinical evaluation and laboratory evidence. The American College of Rheumatology (ACR) has developed specific criteria to aid in the diagnosis of SLE.  The SLICC (Systemic Lupus International Collaborating Clinics) group in collaboration with the ACR recommendations have stated a person is diagnosed with SLE if they have biopsy proven lupus nephritis with ANA or anti-dsDNA antibodies positive laboratories; or if at least 4 of the 11 ACR criteria have been met including at least 1 clinical and 1 immunologic. The American College of Rheumatology (ACR) has developed a mnemonic to help in identifying the diagnostic criteria.  The mnemonic is SOAP BRAIN MD.  If the patient meets at least 4 of those ACR criteria, then a clinical diagnosis of SLE may be made.    S stands for serositis.    O stands for oral ulcers.    A stands for arthritis.    P stands for photosensitivity.    B stands for blood disorders.    R stands for renal involvement.    A stands for ANA (antinuclear antibodies).

Kidneys are the organs most commonly affected by SLE.  Therefore, there is an increased risk of developing complications.  Patients with SLE attacking their kidneys can develop renal failure.  Renal failure is actually the leading cause of mortality in patients with SLE.  It is important to be aware of associated symptoms including itching, nausea, vomiting, chest pain and leg swelling. These can be signs/symptoms associated with renal failure. The CNS can also be affected by SLE.  If the brain is affected by SLE, then symptoms may be present such as:  a headache, dizziness, strokes, seizures, hallucinations and behavioral changes.  Patients with SLE may have difficulty expressing what they are thinking. The hematologic system can also be affected by SLE.  Patients with SLE may have hemolytic anaemia and decreased number of platelets.  The result can be difficulty with blood clotting and increased risk of bleeding.  Vasculitis can also be associated with SLE. The lungs are another organ system that can be targeted by SLE.  These patients are at higher risk of acquiring pneumonia and pleurisy.  If the heart is affected, then the patient can present with pericarditis and increased risk of cardiovascular disease and heart attack. The complication can be associated with the specific organ system that is being attacked by the disruptive immune system.

The signs and symptoms associated with SLE will be based on the organ system or area of the body that the immune system is attacking. If Lupus presents in childhood, initial symptoms that may be present include:    Malaria rash    Ulcers    Renal dysfunction    Protein in the urine    Casts in the urine    Seizures    Low platelet count    Anemia    Fever    Enlarged lymph nodes. Systemic Lupus Erythematosus (SLE) appears most commonly in women of childbearing age.  Three common symptoms associated with Lupus include:    Fever    Joint pain    Rash Many patients present with a variety of generalized symptoms that must be further evaluated.  Symptoms include:    Fatigue    Fever    Joint pain    Weight changes. The musculoskeletal system associated symptoms may include:    Muscle pain    Joint pain    Arthritis    Avascular necrosis If the skin is affected then signs/symptoms may include:    Malar rash (butterfly-shaped rash on the face that spans across the bridge of the nose and cheeks)    Sensitivity to light    Discoid lupus. If the kidneys are affected then signs/symptoms may include:    Renal failure    Acute nephritic disease. When the lungs are involved, then the patient may experience:    Pleural effusions    Pulmonary hypertension    Interstitial lung disease    Pleurisy    Pneumonitis If the Gastrointestinal system is involvement, symptoms include:

Systemic Lupus Erythematosus is an inflammatory autoimmune disease. An autoimmune disease is a disease wherein the body attacks its own normal tissues and organs. This occurs due to an immune system malfunction. The immune system believes that the normal tissues and organs are foreign, and is trying to remove the foreign object from the body. The result is that the body attacks these areas and many complications arise. Patient’s who have Systemic Lupus Erythematosus (SLE or Lupus) may have a variety of different organ systems involved in the disease. Organ systems that may be affected by this disease include joints, skin, kidneys, heart, lungs, brain and blood vessels. There are classic signs and symptoms associated with Lupus and these aid in the diagnosis. Systemic Lupus Erythematosus (SLE) Causes: SLE (Lupus) is an autoimmune disease, and the specific cause is not known. The common theory is that Lupus occurs from both genetic and environmental components. It is thought that exposure to certain environmental factors can actually cause Lupus to develop. Those environmental factors include: sunlight, infection and medication. Exposure to sunlight may activate skin involvement of SLE.  Because Lupus is an autoimmune disease, patients with infections may be at higher risk of triggering SLE.

Diagnosis of Amyotrophic Lateral Sclerosis (ALS)  is very difficult because the symptoms can mimic a multitude of neurologic diseases. In the early stages, it is basically a diagnosis of exclusion. The World Federation of Neurology has developed a method to diagnose ALS that combines clinical diagnosis with electrophysiologic findings.  After life-threatening or other neurological causes have been ruled out, there are certain guidelines to follow when diagnosing the patient. Clinically definite ALS requires that there be signs of upper motor neuron (UMN) and lower motor neuron (LMN) dysfunction in at least 3 different body segments.  If this is present then it can be said that ALS is a definite diagnosis.  If UMN and LMN dysfunction is only in 2 body segments then the diagnosis of ALS is clinically probable. When UMN and LMN dysfunction is present in at least 1 body segment or UMN dysfunction in 1 area with LMN signs observed on EMG in at least 2 limbs, along with lab-supported signs of ALS, then there is a probability of ALS. Clinically possible ALS is another diagnosis type that occurs when there is; UMN and LMN signs in 1 body segment, UMN signs in at least 2 segments alone, or LMN signs in areas above the UMN.