cliffh
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This is a question from NBME form3. Please avoid reading if you are going to take NBME test.
[font="Arial, Helvetica, sans-serif">Which of the following is the most like diagnosis?[font="Arial, Helvetica, sans-serif]b) Juvenile rheumatoid arthritis[font="Arial, Helvetica, sans-serif]d) Psoriativc arthritis[font="Arial, Helvetica, sans-serif]f) Systemic lupus erythematosus[font="Arial, Helvetica, sans-serif]What is your opinion?
Edited by new_n_lost on 08/06/07 - 06:58 AM. Reason: Too Bold Font.
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| reet
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I too would go for F
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| cliffh
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But my question is why this patient has very high Leukocyte (21, 000/mm)count instead of leukopenia (low white blood cell counts) as should be seen in SLE?
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| druas
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what i think why leucocyte are high is that she is on steroids.....steroids causes decrease in synthesis of adhesion molecules which can lead to neutrophilia...
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| kleila
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hmmmm but she uses a cream , a topical steroid treatment, not an orally or parenteral one,,,,,...it's imposiible after my opinion to increse this way the levels of leucocytes after a topical treat.
good q , anyway , i don't know the answer
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| fleuve
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i think it is reiter sydrom, the answer is e
chlamydia urogenital infection which can be non-symptomatic, conjunctivtis, arthritis, oral ulcer, balanitis.
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| druas
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what about JRA??
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| guayoman
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I think it's SLE. Reiter's is pretty good choicee too, but I think the clinical manbifestations go more with SLE. Can Reiter's manifest with and without leukocytosis? And what about the thrombocytopenia in this patient?
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| gabydj
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the corticosteroid creamn is for the malar rash - it's SLE
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| vanshita
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reiter syndrome associated with urethritis conjuctevitis arthritis
good question i m not sure i think it is SLE
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| 26malik
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why not JRA?
- it is juvenile onset,
- 2:1 female to male ratio
- large joints are affected more often
- rheumatoid nodules and RF are usually absent
- abnormal immune regulation
- also skin rash ismay be present.
or it could be SLE
but plz some one explain blood changes.
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| vamsi2004
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wats the answer???/
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| Dragonfly
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from "Wikipedia" 
A patient must present with four of the eleven criteria, either simultaneously or serially, during a given period of observation, to be classified as having SLE — for the purposes of inclusion in clinical trials. - Malar rash (rash on cheeks)
- Discoid lupus (red, scaly patches on skin which cause scarring)
- Photosensitivity (adverse reaction to sunlight)
- Mouth or nose ulcers
- href="http://en.wikipedia.org/wiki/Protein_in_urine" title="Protein in urine">protein in urine, or cellular casts seen in urine under a microscope.
- Seizures or psychosis
- Pleuritis (inflammation of the membrane around the lungs) or pericarditis (inflammation of the membrane around the heart)
- Hemolytic anemia (low red blood cell count), leukopenia (low white blood cell count), lymphopenia (low lymphocyte count) or thrombocytopenia (low platelet count)
- Anti-DNA href="http://en.wikipedia.org/wiki/Serology" title="Serology">serological test for syphilis or antiphospholipid antibody positivity
- Anti-ss DNA (in 70%)
- Antihistone Abs (in 70%) are present in 100% of drug-induced lupus. If negative drug induced lupus can be exluded.
- Positive fluorescence antinuclear antibody test (positive ANA)
- Prolonged PTT
- Anticardiolipin and lupus anticoagulant
- Complement levels are usually decreased
Some patients may have SLE without four criteria and SLE is associated with manifestations other than those listed in the criteria. Dr Graham R.V. Hughes, an authority on lupus in the UK, has published alternative criteria to diagnose SLE[4] in 1982.
A useful mnemonic for these 11 criteria is SOAP BRAIN MD: Serositis (8), Oral ulcers (4), Arthritis (5), Photosensitivity (3), Blood Changes (9), Renal involvement (proteinuria or casts) (6), ANA (11), Immunological changes (10), Neurological signs (seizures, frank psychosis) (7), Malar Rash (1), Discoid Rash (2).
hope that helps 
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| doc179
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what is it , JRA or SLE? I chose SLE.
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| fongch
Forum Elite
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Shouldn't Reiter syndrome present w/ conjuctivitis and urethritis too?
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| doc179
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yes, thats why thats not the answer. I found the same question in another thread and they have finalised the answer as SLE.
GL
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| ManuNastai
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hmmm... ok, then what about that high leukocyte number?
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