About 20% of patients with systemic lupus erythematosus (SLE) present with hospitalization as the first indication of the disease. Kapsala et al reported criteria to aid in the early recognition of these patients. The authors are from multiple institutions in Greece, Crete and Cyprus.
Reasons for admission include:
(1) neuropsychiatric event including cerebrovascular event
(2) cytopenia
(3) nephritis
(4) thrombotic event (pulmonary embolism, other)
(5) myocarditis or vasculitis, including mesenteric vasculitis
(6) pericarditis and/or pleuritis
(7) pulmonary disease
Most patients were diagnosed within 3 months of the index admission, but 20% may have a delay in diagnosis.
Criteria for diagnosis of SLE:
(1) SLERPI (SLE Risk Probability Index) score > 7
(2) SLERPI score >= 5 AND fever
(3) SLERPI score >= 5 AND thrombotic event
Patients with neuropsychiatric symptoms may be a challenge to diagnose. A high index of suspicion for SLE should be maintained for these patients if no underlying cause is identified during the workup.
