Question

Your patient is a married 47 year old white female homemaker with 2 children and an 18 year history of systemic lupus erythematosus (SLE). She has no known allergies. The pt takes an occasional naproxen for joint pain and antacid for heartburn but no other prescription or OTC (over the counter) medication. She neither smokes nor drinks alcohol (ETOH). Except for lupus, the patient's medical history is unremarkable. She is 5 feet 5 inches in height and weighs 102 pounds which is a decrease in weight of 23 pounds since her last physical examination nearly a year ago. She has had several small patches of hair loss on her head and her joints often hurt. Her ESR (erythrocyte sedimentation rate) is elevated at 70. She has a red rash on the sun exposed parts of her skin that looks like a vasculitis. She has 4 brothers and 3 sisters. An older sister has rheumatoid arthritis (RA) and an aunt with pernicious anemia and her deceased mother had Graves disease. What is the significance of the patient's family history? What is the pathophysiology that underlies her hair loss and the abnormal ESR? What causes vasculitis in SLE? Why might prednisone improve the rash?

          Your patient is a married 47 year old white female homemaker with 2 children and an 18 year history of systemic lupus erythematosus (SLE). She has no known allergies. The pt takes an occasional naproxen for joint pain and antacid for heartburn but no other prescription or OTC (over the counter) medication. She neither smokes nor drinks alcohol (ETOH). Except for lupus, the patient's medical history is unremarkable. She is 5 feet 5 inches in height and weighs 102 pounds which is a decrease in weight of 23 pounds since her last physical examination nearly a year ago. She has had several small patches of hair loss on her head and her joints often hurt. Her ESR (erythrocyte sedimentation rate) is elevated at 70. She has a red rash on the sun exposed parts of her skin that looks like a vasculitis. She has 4 brothers and 3 sisters. An older sister has rheumatoid arthritis (RA) and an aunt with pernicious anemia and her deceased mother had Graves disease.
What is the significance of the patient's family history?
What is the pathophysiology that underlies her hair loss and the abnormal ESR?
What causes vasculitis in SLE? Why might prednisone improve the rash?

Your patient is a married 47 year old white female homemaker with 2 children and an 18 year history of systemic lupus erythematosus (SLE). She has no known allergies. The pt takes an occasional naproxen for joint pain and antacid for heartburn but no other prescription or OTC (over the counter) medication. She neither smokes nor drinks alcohol (ETOH). Except for lupus, the patient's medical history is unremarkable. She is 5 feet 5 inches in height and weighs 102 pounds which is a decrease in weight of 23 pounds since her last physical examination nearly a year ago. She has had several small patches of hair loss on her head and her joints often hurt. Her ESR (erythrocyte sedimentation rate) is elevated at 70. She has a red rash on the sun exposed parts of her skin that looks like a vasculitis. She has 4 brothers and 3 sisters. An older sister has rheumatoid arthritis (RA) and an aunt with pernicious anemia and her deceased mother had Graves disease.
What is the significance of the patient's family history?
What is the pathophysiology that underlies her hair loss and the abnormal ESR?
What causes vasculitis in SLE? Why might prednisone improve the rash?

Added by Joseph C.

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