Systemic lupus erythematosus: an interdisciplinary tandem of dermatologist and rheumatologist

Abstract

Abstract Relevance. Systemic lupus erythematosus is a complex autoimmune disease characterized by diverse clinical symptoms and significant individual variability in each patient. The manifestations of systemic lupus erythematosus can range from mild to progressive damage to vital organs, which determines the difficulties of early diagnosis of this pathology. Due to the polymorphism of the course of systemic lupus erythematosus patients at the onset of the disease can consult doctors of any specialty. Increased awareness of both dermatologists and doctors of related specialties will contribute to clinical alertness already at the outpatient stage of providing medical care to patients, improving the quality of life of this group of patients and the likelihood of a favorable outcome. When studying the activity of the process and the diagnosis of systemic lupus erythematosus, a characteristic clinical picture and laboratory tests are important, including: a blood test for antinuclear factor on HEp-2 cells with determination of the type of glow of the nucleus, antibodies to phospholipids of the IgG and IgM class, lupus anticoagulant in blood plasma, rheumatoid factor, antibodies to double-stranded DNA, IgG autoantibodies to AMA-M2 (by immunoblot method), antibodies to cardiolipins. Currently, the study of various variants of the course of systemic lupus erythematosus remains relevant, the search for new approaches and informative diagnostic methods for this pathology, the development of modern algorithms and programs for diagnosing patients at all stages of outpatient and inpatient care. The EULAR/ACR 2019 classification criteria represent a modern and optimized clinical approach to the diagnosis of systemic lupus erythematosus. The article describes three clinical cases of early manifestations of systemic lupus erythematosus in dermatological practice. The purpose of the work. To cite our own clinical observations that prove the importance of expanding the range of diagnostic measures in dermatology, as well as the high effectiveness of the tandem of a dermatologist and a rheumatologist in diagnosis for accurate verification of the diagnosis of systemic lupus erythematosus. Materials and methods. Three clinical cases of systemic lupus erythematosus, manifested from skin symptoms, are presented. Results. In the clinical cases presented by us, concomitant, comorbid diseases were excluded, and before the onset of skin clinical symptoms, patients were considered practically healthy. In such patients, there is a risk of delaying the diagnostic process due to the lack of screening for predictive biomarkers (antinuclear antibodies, antibodies to double-stranded DNA, antibodies to phospholipids) in the routine practice of polyclinic and inpatient dermatovenerological departments. Any non-specific dermatological symptoms can lead to delaying the diagnosis and delaying the start of adequate treatment. The presented clinical observations show the early need for a thorough differential diagnostic search, interdisciplinary interaction with other specialists, which will improve the quality of medical care at an early stage. Conclusion. The expansion of the range of diagnostic procedures, as well as an interdisciplinary approach, make it possible to prescribe treatment in a timely manner, improve the prognosis, and avoid long periods of disability.