Failure to Diagnose & Delay in Treatment of Lupus Erythematosus

Evaluate breaches in the standard of care when analyzing a Failure to Diagnose & Delay in Treatment of Lupus Erythematosus

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Joint pain and swelling
    Facial rash
    Photosensitivity
    Oral ulcer
    Pleuritic or pericardial chest pain
    Renal disorder- proteins in urine
    Neurological symptoms- seizures
    None elicited
    Answer unknown
    Why is this important?
    Systemic lupus erythematosus (SLE) is an autoimmune disorder of unknown etiology that affects numerous organ systems including the renal, cardiovascular, gastrointestinal and central and peripheral nervous systems. There are many atypical presenting patterns that may result in significant delays in diagnosis of systemic lupus erythematosus.
    (2008) 20 EOMSCA 4 651-662

  • Which of the following risk factors were elicited from the patient? (Choose all that apply) Why is this important?
    Answer this question
    Risk factors are useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.
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  • Was a physical examination performed? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.
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  • Was the presence of co-existing infection detected? Why is this important?
    Answer this question
    Patients with systemic lupus erythematosus are more susceptible to infection. Coexisting infection with systemic lupus erythematosus must not be missed by the primary care physicians. If the temperature is greater than 102ºF (39ºC), a source of infection should be sought.
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  • Was the renal involvement evaluated? Why is this important?
    Answer this question
    Renal involvement must always be evaluated for patients with systemic lupus erythematosus.
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  • Which of the following diagnostic laboratory tests were performed? (Choose all that apply) Why is this important?
    Answer this question
    Routine laboratory studies can provide important clues to diagnosis.
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  • Was an anti-nuclear antibody (ANA) test or a fluroscent anti-nuclear antibody (FANA) test performed? Why is this important?
    Answer this question
    The presence of anti-nuclear antibody is the cardinal feature in systemic lupus erythematosus and occurs in over 90% of cases, depending upon the titer of the anti nuclear antibody. Although anti-nuclear antibody -negative systemic lupus erythematosus can rarely occur, a negative anti-nuclear antibody will call the diagnosis into question. Measurement of anti-nuclear antibody subtypes may also be performed.
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  • Did the patient test positive for anti-nuclear antibody / fluorescent anti-nuclear antibody levels? Why is this important?
    Answer this question
    The anti-nuclear antibody test is highly sensitive for systemic lupus erythematosus. A positive anti-nuclear antibody test result can occur in many other disease states as well as in a large number of healthy individuals. A negative fluorescent anti-nuclear antibody test result essentially rules out systemic lupus erythematosus.
    (2008) 20 EOMSCA 4 651-662

  • Did the clinician perform an anti ds-deoxyribo nucleic acid test on the patient? Why is this important?
    Answer this question
    In a patient with positive anti-nuclear antibody value, additional tests such as an anti ds-DNA test will confirm the diagnosis of lupus erythematosus.
    (2008) 20 EOMSCA 4 651-662

  • Was the patient diagnosed with lupus erythematosus? Why is this important?
    Answer this question
    Treatment and therapies vary for different connective tissue disorders.
    (2008) 20 EOMSCA 4 651-662

  • Was the patient referred to a specialist? Why is this important?
    Answer this question
    Once priorities and goals have been agreed on, referral to the appropriate professionals should be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines should be utilized to enable all patients to achieve their maximum potential.
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  • Were antibiotics administered in the febrile patient? Why is this important?
    Answer this question
    Low-grade fever indicates active disease, and high fever indicates possible infection.
    (2008) 20 EOMSCA 4 651-662

  • Was treatment initiated for lupus erythematosus? Why is this important?
    Answer this question
    Because there is no cure for systemic lupus erythematosus and complete remissions are rare, the patient and medical treatment team must devise strategies to control acute flare-ups of the disease and develop medication protocols in which symptoms are maintained at an acceptable level.
    (2008) 20 EOMSCA 4 651-662

  • Were the modifiable risk factors for premature atherosclerosis controlled? Why is this important?
    Answer this question
    Patients with systemic lupus erythematosus are likely to suffer from premature atherosclerosis, so primary care physicians should encourage control of modifiable risk factors for atherosclerosis including blood pressure, diet and exercise.
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  • Was steroid therapy recommended? Why is this important?
    Answer this question
    Cortico-steroids have been the mainstay in the treatment of patients with SLE.
    (2008) 20 EOMSCA 4 651-662

  • Was health education provided? Why is this important?
    Answer this question
    Extensive health education must be provided to any patient initiating steroid maintenance therapy.
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  • Were periodic follow-up visits recommended? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise. Regular check-ups ensure that changes in health are quickly assessed and remedied.
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  • Was corticosteroid therapy stopped abruptly? Why is this important?
    Answer this question
    Corticosteroid therapy should not be stopped suddenly in systemic lupus erythematosus as it leads to complications. The dose must be gradually tapered down.
    Click here for additional information at ClinicalKey.com