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captainstandup

"Lupus Crisis"

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I recently transferred a 20 year old patient who was reported to be in a "Lupus crisis". Just like most other medics I know, we were only briefly exposed to this disease process in school and rarely see it in the field. The patient had the classic "butterfly rash" along with many other S/S.

I, of course, have been searching / surfing the net ad reading books for more information and wanted to include my beloved emtcity in the process of learning more about this disease. So tell me more please, all information is pertinent but specifically implications that affect EMS or Interfacility transport ( very long distance) care are of specific interest.

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Lupus is broad and generic term. There are several types of Lupus, as it is an autoimmune disease and can affect multiple areas throughout the body. Within the past few years increasing research and treatment modalities have reduced the morbidity rate, for the type that affected nervous, kidney and heart but still is a serious disease. Although it is a well researched disease, there is still a lot that is unknown.. like the etiology.

Basically, you name it, they've got it. A bad disease that is treated but never cured.

The type you described which is very common is called Systemic Lupus Erythematosus, and can affect or spread into various areas of the body.

Here is a very brief synopsis of the major areas:

Dermatological- Like you described is usually seen up to 30% have it, and over half get it at some time. The typical rash you described "butterfly rash" (malar rash). Again usually a thick, red, patchy type. Sometimes it will increase from sunshine and those that have Lupus should avoid direct sunlight.

Hematological- Anemia (low Hgb) and low iron deficiency. Many may have low platelet and low WBC. Which in turns can increase or prolong the PTT (clotting factor) caused by antiphospholipid antibodies. This of course can present as bleeding disorders.

Muscular and joint: Common areas of pain and discomfort. Most will have some form of joint pain (usually wrists).

Cardiac- common all the "carditis". Pericarditis, myocarditis, endocarditis can occur. Of course effecting the valves, and also have occurrence atherosclerosis.

Lungs- pleural effusion (fluid level in the lung), P.E., pulmonary hypertension

Kidneys- poor renal clearance and may have asymptomatic (painless) hematuria. Later renal failure.

I won't go into the greater detail. It is a very complex disease. After reviewing it, I agree I have seen it more in women and it is not age discriminatory. I have worked with several medics that had it. I realize that it is not that easy to place a correct diagnosis as well and many of the symptoms have similar appearance to carcinoma.

The general treatment is supportive for the problem at hand. Many maybe under steroid use and are actually presenting complications related to that. Again, since it is so diverse caution has to be used to label one area.

R/r 911

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Excellent info RidRyder and thanks for the effort. I must admit being ignorant of the parallel with carcinoma. I agree Lupus is a very complex disease and at this point it seems the effect on the kidneys and concomitant systemic impact could be the most significant.

I was also surprised by the similarities between this patient's symptoms and a patient we frequently transported who had severe sickle cell anemia, although I understand there is no relationship.

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Another great place for info is emedicine.com

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Thanks Doc, by the way can I, by virtue of your avatar, assume you were happy with the outcome of the superbowl?

If it wasn't going to be the Dolphins (though they were close) I am happy with the Giants.

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I had several Lupus patients over the years. Mostly inter-hospital transfers to St. Louis. I think it was either at St.Louis Univ. or Barnes-Jewish where they had a Lupus study going on. But most of what I know of Lupus it's self was from when I was being tested for it. If I remember right 85% of Lupus patients were women. And for the most part it's still a mystery disease. I did test negative for it, but I'm suppose to be tested every two years. So it's about time to do it again. I'm also suppose to be re-tested for ALS (Lou Gehrig Disease).

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If it wasn't going to be the Dolphins (though they were close) I am happy with the Giants.

I could feel the Dolphin loyalty! I would likely have pulled for the "taliban" over the Patriots as only a true Dolphins fan would! By the way where is Bob Greise these days, God knows we need him and hey, he's only 63!

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I could feel the Dolphin loyalty! I would likely have pulled for the "taliban" over the Patriots as only a true Dolphins fan would! By the way where is Bob Greise these days, God knows we need him and hey, he's only 63!

I know this is getting way off topic, but if it's not Dallas, New Orleans, or Miami playing, I don't really care. But I am glad the Giants pulled it out. =D>

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I wanted a New York team: the Giants are in New Rutherford (the Meadowlands), New Jersey.

Then, again, I haven't really followed football from when Joe Willie Namath was still throwing quarterback, wearing pantyhose, and man styled mink coats, with the Shea Stadium Jets, back in 1969!

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