Case Study 24: Chronic Pain in a Young Woman - CRASH! Medical Review Series

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(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)

[@soniasun1]

Thank you for your help and time.

[@woloabel]

(On Tuesday of February 21, 2023). On the matter of Systemic Lupus Erythematosus (SLE) Presenting with Chronic Pain (Arthralgia) in A Young Woman (15-50 years of Age): SSx: 1) Malar Rash is Pathognomonic of SLE and is a Good Indication For Screening via Serology of ANA Titers; 2) Discoid Rash; 3) Photosensitivity; 4) Oral Ulcers; 5) Arthritis of Non-erosive with two or more Peripheral Joints; 6) Serositis in the Locality of the Pleura (Pleuritis/Pleursy) or Pericardium (Pericarditis); 7) Renal Involvement (Nephrotic/Nephritic Syndrome) with Proteinuria or Casts within Urine; 8) Neurologic Disorders in the Form of Seizures and/or Psychoses; 9) Hematologic Disorder of Pancytopenia (Hemolytic Anemia, Thrombocytopenia and Leukocytopenia); 10) Immunologic Disorder in the Form of Autoimmunity (Via Anti-dsDNA Antibodies, Anti-Smith Antibodies and Anti-Phospholipid Antibodies [APA]); 11) Positive Anti-Nuclear Antibodies (ANA); Diagnosis of SLE with Lupus Nephritis (Nephritic Syndrome) and Anemia of Chronic Disease (ACD); Treatment (Tx): 1) Methylprednisolone (IV Infusion); 2) DMARDs Antimalarial (Hydroxychloroquine); 3) Renal Biopsy to further Characterize the Disease Process within the Kidney; 4) Immunosuppressants with Renal Failure and/or Involvement and 5) NSAIDs for Chronic Pain (Arthralgia); 6) Advise of Side Effects of Medications; 7) Sun Exposure (Not More than 20 Minutes Per Day) and the Use of Sunscreen (Prophylaxis); 8) Referral to Specialist: 1) Rheumatology for Ongoing Management; 2) Nephrology for Ongoing Complications of Nephritic Syndrome And Biopsy; Any End-Stage Disease Process with entail Dialysis therewith; 9) Renal Insufficiency Warrants Admissions to Intensive Care Unit (ICU) for IV Infusions, Complication Prevention and Further Stabalization of Patient; Management (Mx): 1) Hydroxychloroquine (Antimalarials or Disease Modifying Anti-Rheumatic Drugs [DMARD] Antimalarials Drug Class); Common Side Effects are Retinitis; 2) PO or IV Glucocorticosteroids (Prednisone/Methylprednisolone Respectively) tapered to Lowest Dose (Not Longer than 6 Months); Side Effects are Weight Gain And Osteoporosis/Osteopenia; 3) NSAIDs for Pain; 4) Mycophenolate (Lupus Nephritis) Immunosuppressant Drug Class (Mechanism of Action [MOA] of Inosine Monophosphate Dehydrogenase Inhibition); Complications (Cx) of SLE: 1) Medication Adverse Side Effects (Immunosuppression); 2) Antiphospholipid Syndrome (APS); 3) Progression of Renal Disease to End-Stage Renal Disease (ESRD); 4) Interstitial Lung Disease; 5) Pregnancy Loss; 5) Neonatal Lupus (Heart Block) is a Matter of Obstetrics (And Gynecology); Aetiology (Ax) of SLE is Idiopathic But Risk Factors (RFs) and Associations (Ax) have Been Made (Autoantibodies and Young Female [White]); Pathology of Autoimmunity is characterized by Relatively Asymptomatic Periods Punctuated by Exacerbations or "Flare ups" (Crohn's Disease-like, Ulcerative Colitis and Multiple Sclerosis Similarity), where Relapsing Subjects after Recovery is the norm; Epidemiology (Ex) is significant for Female-Male Ratio (90% Females); Goodness, My first Systemic Lupus Erythematosus Case (SLE). Not Really, Just Kidding. The Subject was actually End-Stage Renal Disease and necessitated Dialysis and Intensive Care Unit Around the Clock Monitoring and Attention. MD Paul W. Bolin, es geht sehr gut zu entwickeln aber man auch muss vernichten sich oder Ich wuerde. Heil!

[@ravinathmapa6631]

Great 👍👍

[@brendannokam4167]

There has not been a fully scientific resolution to the level of category A recommendation for what all the uses of HQ are for us to make emphatic statement as if of full evidence based fact. What needs to be done is finding of evidence for or against not hypothesis thrown around as fact. Never is not a word in medicine.

[@waelfadlallah8939]

Why we give immunosuppressant (mycophenolate) in case of lupus nephritis when we are giving already a known immunosuppressant (steroids) isn't that should be contraindicated ?

[@fdku4006]

great case and so helpful 🙂 but I wish you could include more people of color in dermatological diseases

[@pwbmd]

Noted!