原文題目

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口腔病理科 On-Line KMU Student Bulletin

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原文題目(出處)： Systemic Lupus Erythematosus: A review for Dentists (JCDA Nov.2007,Vol.73, No.9)

原文作者姓名： Jonathan B Albilia, David K Lam, Cameron ML Clokie, George KB Sandor

通訊作者學校： Univerity of Toronto, Ontario 報告者姓名(組別)：彭玠中 (Intern B)

報告日期： 97/1.14 內文：

Abstract:

1. SLE(Systemic Lupus Erythematosus) is a chronic inflammation disease with far-reaching systemic implications.

2. Autoimmune rheumatic disease

3. Women (especially those in 30s and 40s) are affected more frequently.

4. It affects skins, joints, kidneys, lungs, nervous system, serous membranes

(ex.pleura), mucous membranes, musculoskeletal, hematologic and other organs.

Pathogenesis:

1. Location, Ethnicity, Sunlight, Infections (ex.EBV), drugs.

2. May be generalized or organ-specific

3. Formation of soluble immune complexes (mainly IgG and IgM)

4. Because of the affinity of the antibody, the kidneys, lungs, and joints, are the most targeted.

5. Tissue damage is caused by platelets and neutrophils.

6. The lesion contains primarily neutrophils and deposits of immune complexes and complements(C3a,C4a,C5a)

7. Type Ⅲ hypersensitivity reaction triggered by an endogenous antigen.

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Clinical Presentation

A. Constitutional symptoms:

a. Arthralgia (earliest, asymmetric and migratory ) b. Fatigue

c. Malaise d. Myalgia

e. Arthritis (hands and tendons, painful, nondestructive) f. Deformities (often due to tendon inflammation) B. Skins:

a. Malar, Butterful rash

b. Generalized sun-induced rash c. Epithelial atrophy

d. Hair loss (due to follicle plugged with keratin) C. Oral:

a. Desquamative gingivitis b. Marginal gingivitis c. Erosive mucosal lesions

d. Odontogenic and other head/neck infections with no obvious symptoms (due to a reduced immune response)

e. Temporomandibular joints disorder f. Sjögren’s syndrome (in advanced case) g. Caries in p’ts with Sjögren’s syndrome

h. Suboptimal oral hygiene (due to painful oral lesions) D. Neural systems:

a. Headache, Migraines b. Depression

c. Seizures d. Phychosis E. Renal disease:

a. Lupus nephritis b. Chronic renal failure F. Respiratory systems:

a. Cough, rapid and shallow breathing (in active lung disease) b. Chest pain due to deep inspiration

c. Pleural effusion

d. Pneumonia (especially hospitalized patients) IgG

receptor

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G. Cardiac features:

a. Pericarditis b. Endocarditis

c. Rheumatic valvular damage

d. Vasculitis (lead to multi-organ dysfunction)

One may have SLE if he/she meets any 4 of 11 criteria

(simultaneously or in succession)

(American college of Rheumatology,1997)

Serologic tests:

a. in suspected SLE patients

Histopathology of Oral lesions

a. similar with lichen planus and erythema multiform b. band-like subepithelial inflammation

c. periodic acid-Schiff staining in the basement membrane zone

d. Immunofluorescent testing shows immunoglobulin and complement deposition along the basement membrane zone in a granular pattern

(character of Type Ⅲ hypersensitivity)

Treatments:

a. prevention, reversal of symptoms, maintaining states of remission and alleviation

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of symptoms b. Drugs:

1. Nonsteroidal anti-inflammtory drugs(NSAIDs)

2. Cyclooxygenase-2 selective inhibitors (Cox-2 inhibitors) 3. Antimalarials(ex. Chdroxychloroquine) for skin manifestation

Ærelieving musculoskeletal complaints and mild serositis

4. Systemic corticosteroids (ex.prednisone) in patients with multi-organ involvement

Perioperative management by the dentists a. preventive dental care

b. monitors for head and neck infections

c. In SLE with thromboembolic events, careful managed with the anticoagulation therapy

d. In SLE with renal dialysis, dental management should be planned one day after.

e. Alteration in drug with renaltoxicity

(ex.tetracyclines, Cephalosporins, Antifungals, NSAIDs, Penicillins) ÆAcetaminophens, Narcotics, Clindamycins

f. Attentions with drugs interactions

Prognosis:

a. Variable

b. Death due to SLE was 5 times higher in women than in men, 3 times higher in black than in white.

c. Multi-organ infections or lupus-related immunosuppresion.

Conclusions:

a. SLE can run varied clinical course, ranging from a relative benign illness to a rapid progressive disease, with fulminant organ failure to death.

b. Dentists should be aware of the clinical S/S and keep the good oral hygiene , closely follow up with dental and oral infections, and assist with the diagnosis of mucocutaneous lesions of the head and neck.

題號題目

1 在 SLE 的病人中，約有 50%會因此造成腎臟功能的影響，請問在這些病人上如果要使用抗生素，下列何者較為理想?

(A) Penicillins (B) Tetracycline (C) Clindamycins (D) Cephalosporins

答案(C) 出處：Oral and Maxillofacial pathology edi.2 p.689

題號題目

2 對 SLE 的病人做免疫螢光的測驗，常會發現 lupus band test(+)下列何者不是這項測驗中常發現的物質?

(A) IgG (B) IgM

(C) Complement components (D) IgE

答案(D) 出處：Oral and Maxillofacial pathology edi.2 p.692