It's not Just Growing Pains: A Guide to Childhood Muscle, Bone, and Joint Pain, Rheumatic Diseases, and the Latest Treatments

By Thomas J. A. Lehman | Go to book overview

11
Systemic Lupus
Erythematosus

Margaret was fourteen years old when I met her. She did well in junior
high school but seemed lazy over the summer before starting high
school. When high school began she did not seem to be making new
friends and complained of being tired. School was hard. Her family
just assumed she needed to get used to high school. As the semester
progressed she seemed to be spending more time in her room. Her
parents got phone calls that she was not performing well in school
and her grades were poor. She was losing weight, irritable, and disin-
terested. By December there were questions about drug use, difficulty
adjusting to the new school, and so on.

In January the school requested a psychiatric evaluation. The psychiatrist asked for a pediatric evaluation. Fortunately, the pediatrician ran a full set of blood tests and found that she was anemic, with an elevated sedimentation rate and a positive test for antinuclear antibody (ANA). She was referred to my office. When I walked into the room and shook her hand, she cried because her hands hurt when I squeezed. She had not realized that she had arthritis. She had no rash but had confirmatory findings of SLE on her blood and urine tests. As I write this, I saw Margaret yesterday. It’s eight years later and she is finishing college and doing very well. She wants to teach English.


WHAT IS SYSTEMIC LUPUS ERYTHEMATOSUS?

In textbooks, SLE is defined as a complex autoimmune disease with protean manifestations. That does not translate into plain English very well. Typically, SLE is a disease that affects teenage girls and young adult women. Less frequently, SLE occurs in both older and younger individuals and in

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