Systemic lupus erythematosus: early diagnosis and differential diagnosis (Electronic educational course, 36 hours)
Category of students: doctors-specialists in the areas of training: "Therapy", "General medical practice (family medicine), "Rheumatology", "Pediatrics", "Pulmonology", "Cardiology", "Nephrology", "Gastroenterology", "Dermatovenerology", "Neurology", "Phthisiology".
The complexity of the program: 36 academic hours.
Form of study: part-time with the use ofdistance learning by means of electronic educational environment and interactive communication technologies.
Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease of unknown etiology, the pathogenesis of which is based on the hyperproduction of organ - specific autoantibodies to the components of the cell nucleus with the development of immuno-inflammatory damage to tissues and internal organs. The characteristic features of SLE are a wide range of clinical and laboratory manifestations; a chronic, often unpredictable nature of the course, with alternating remission and exacerbations, as well as a variety of clinical forms and variants of the course of the disease. Pathogenetic processes in SLE can lead to the development of life-threatening conditions, a significant deterioration in quality and a decrease in life expectancy. In the modern world, SLE has ceased to be considered a rare pathology: the incidence varies from 4 to 250 cases per 100,000 population, averaging 50-70 cases. Women of young, childbearing age are mainly affected, but the disease can develop at any age (including in children and elderly patients) and in men. In the early stages of SLE, diagnostic difficulties often arise, since the clinical manifestations are non-specific and similar for different diseases (general symptoms of inflammation; damage to the joints, serous membranes, skin, reticuloendothelial system; hematological disorders, trophic disorders, etc.). Atypical variants of the debut are possible, and therefore patients seek primary care from doctors of therapeutic specialties who do not have sufficient skills in curating such patients. There are errors in the interpretation of laboratory and instrumental methods of examination. During the first year of the disease, difficulties with establishing a correct diagnosis occur in half of SLE patients, and in every fifth patient, the interval from the appearance of the first symptoms to the verification of reliable SLE can reach five years.
To date, there is strong evidence that the prognosis of any diseases largely depends on timely diagnosis. Early diagnosis of SLE and identification of prognostically unfavorable factors at the initial stage of the disease are necessary for the use of an effective patient management strategy that can potentially change the course of the disease and improve the outcomes of the disease. It is also proved that late diagnosis and postponement of the appointment of modern adequate treatment methods leads to an increase in disability, a reduction in the duration and quality of life of patients with SLE and increases the socio-economic burden of this pathology.
Thus, the expansion of doctors ' knowledge about the features of one of the most prominent and common representatives of systemic autoimmune rheumatic diseases – systemic lupus erythematosus; modern diagnostic methods, including in the early stages; prognostically unfavorable factors of SLE, variants of the course of the disease and its forms, is an urgent need and explains the need for the education of doctors of therapeutic and related specialties.
As part of the course, we:
- Let's consider the main aspects of the etiology and pathogenesis of SLE
- Let's analyze the features of physical examination and collection of anamnesis of SLE patients at the onset of the disease
- Let's analyze the options for the debut and the features of the early stage of SLE
- We will discuss modern diagnostic and classification criteria of the disease
- We will consider the formulation of the preliminary diagnosis and the preparation of a plan for laboratory and instrumental examinations of the patient, the algorithm for verifying the diagnosis in accordance with thecurrent international statistical classification of diseases (ICD)
- We will determine the scope and sequence of diagnostic measures in patients with early stages of SLE
- We will discuss the interpretation of the results of clinical, laboratory and instrumental examinations
- Let's analyze the algorithm of differential diagnosis in patients with early stage stage of SLE
- We will discuss the need and scope of additional survey methods
- We will hold discussions on topical issues of diagnosing SLE patients at the outpatient stage
- Let's consider modern methods of assessing activity and damage in SLE, tactics for identifying prognostically unfavorable factors
- Let's consider the variants of SLE depending on age and gender, the variants of the course of systemic lupus erythematosus
- We will analyze clinical examples of patients with SLE, including those using differential diagnostic algorithms
Speakers of the advanced training course:
- Natalia G.Klyukvina, Doctor of Medical Sciences, Chief Researcher of the Center for Diagnosis and Treatment of Autoimmune Diseases of the State Medical Institution of the Moscow State Scientific Research Center named after A. S. Loginov DZM;
- Lukina Galina Viktorovna, Doctor of Medical Sciences, Professor, Head of the Department of Rheumatology of the State Medical Institution of the Moscow State Medical Center named after A. S. Loginov DZM.