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SLE(全身性エリテマトーデス)の疾患活動性

SLE(全身性エリテマトーデス)の疾患活動性(1)

現代医療では、SLEの症状・疾患活動性に基づいてステロイド、免疫抑制剤を投与していきます。その指標としてSLEDAIおよびBILAGがあります。

SLEDAI(1992)

Descriptor Definition
8 Seizure
(痙攣)
Recent onset. Exclude metabolic, infectious or drug cause
8 Psychosis
(精神症状)
Altered ability to function in normal activity due to severe disturbance in the perception of reality. Include hallucinations, incoherence, marked loose associations, impoverished thought content, marked illogical thinking, bizarre, disorganized, or catatonic behavior. Excluded uremia and drug causes.
8 OrganicBrain Syndrome
(脳の病変)
Altered mental function with impaired orientation, memory or other intelligent function, with rapid onset fluctuating clinical features. Include clouding of consciousness with reduced capacity to focus, and inability to sustain attention to environment, plus at least two of the following: perceptual disturbance, incoherent speech, insomnia or daytime drowsiness, or increased psychomotor activity. Exclude metabolic, infectious or drug causes.
8 Visual Disturbance
(視覚異常)
Retinal changes of SLE. Include cytoid bodies, retinal hemorrhages, serious exodate or hemorrhages in the choroids, or optic neuritis. Exclude hypertension, infection, or drug causes.
8 Cranial Nerve Disorder
(脳神経異常)
New onset of sensory or motor neuropathy involving cranial nerves.
8 Lupus Headache
(頭痛)
Severe persistant headache: may be migrainous, but must be nonresponsive to narcotic analgesia.
8 CVA
(脳血管病変)
New onset of cerebrovascular accident(s). Exclude arteriosclerosis.
8 Vasculitis
(血管炎)
Ulceration, gangrene, tender finger nodules, periungual, infarction, splinter hemorrhages, or biopsy or angiogram proof of vasculitis
4 Arthritis
(関節炎)
More than 2 joints with pain and signs of inflammation(i.e. tenderness, swelling, or effusion).
4 Myositis
(筋肉炎)
Proximal muscle aching/weakness, associated with elevated creatine phosphokinase/aldolase or electromyogram changes or a biopsy showing myositis.
4 Urinary Casts
(尿円柱)
Heme-granular or red blood cell casts.
4 Hematuria
(血尿)
>5 red blood cells/high power field. Exclude stone, infection or other cause.
4 Proteinuria
(タンパク尿)
>0.5gm/24hours. New onset or recent increase of more than 0.5gm/24 hours.
4 Pyuria
(膿尿)
>5 white blood cells/high power field. Exclude infection.
2 New Rash
(新たな皮疹)
New onset or recurrence of inflammatory type rash
2 Alopecia
(脱毛)
New onset or recurrence of abnormal, patchy or diffuse loss of hair.
2 Mucosal Ulcers
(粘膜潰瘍)
New onset or recurrence of oral or nasal ulcerations
2 Pleurisy
(胸膜病変)
Pleuritic chest pain with rub or effusion, or pleural thickening.
2 Pericarditis
(心膜炎)
Pericardial pain with at least 1 of the following: rub, effusion, or electrocardiogram confirmation.
2 Low complement
(補体値の低下)
Decrease in CH50, C3, or C4 below the lower limit of normal for testing laboratory.
2 Increased DNA binding
(DNA抗体上昇)
>25% binding by Farr assay or above normal range for testing laboratory.
1 Fever
(発熱)
>38℃, Exclude infectious cause
1 Thrombocytepenia
(血小板減少)
<100,000 platelets/mm3.
1 Leukopenia
(白血球減少)
<3,000 WBC/mm3. Exclude drug causes.

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