Fw: explain like from Caroline

December 24, 2002

----- Original Message -----

From: " Kathi " <pureheart@...>

Sent: Sunday, December 22, 2002 12:04 AM

Subject: Re: explain " like " from Caroline

> Updating the American College of Rheumatology Revised Criteria for the

> Classification of Systemic Lupus Erythematosus

>

> To the Editor:

> In 1982, the Diagnostic and Therapeutic Criteria Committee of the

> American College of Rheumatology (ACR)published revised criteria for the

> classification of systemiclupus erythematosus (SLE) (1). During the

> ensuing decade several investigators, including Drs. Graham and

> Donato Alarcon-Segovia, among others, have described the presence and

> clinical associations or antiphospholipid antibodies in patients with

> SLE, as well as the occurrence of theprimary antiphospholipid syndrome

> (2-5). In 1992, Piette and colleagues suggested that the ACR revised

> criteria be reevaluated in light of the above discoveries (6).

> At the request of Dr. Eng Tan, the Diagnostic and Therapeutic Criteria

> Committee of the ACR reviewed the 1982 revised criteria for SLE and

> recommended tne following revisions to criterion number 10 ( " Immunologic

>

> disorder " ),which were approved by the Council on Research and the Board

> of Directors:

>

> 1. Delete item 10(a) ( " Positive LE cell preparation " ), and

>

> 2. Change item lO(d) to " Positive finding of antiphospholipid antibodies

> based on 1) an abnormal serum level of IgG or IgM anticardiolipin

> antibodies, 2) a positive test result for lupus anticoagulant using a

> standard

> method, or 3) a false-positive serologic test for syphilis known to be

> positive for at least 6 months and confirmed by Treponema pallidum

> immobilization or fluorescent treponemal antibody absorption

> test. " Standard

> methods should be used in testing for the presence of antiphospholipid

> (7-10). Publication of this letter will allow basic and clinical

> investigators in SLE to not only use, but also cite, the modification of

> the 1982

> criteria.Marc C. Hochberg, MD, MPH for the Diagnostic and Therapeutic

> Criteria Committeee of the American College of Rheumatology1. Tan EM,

> Cohen AS, Fries JF, Masi AT, McShane DJ, RothfieldNF, Schaller

> JG, Talal N, Winchester RJ: The 1982 revised criteria for the

> classification of systemic lupus erythematosus. Arthritis Rheum

> 25:1271-1277, 1982

>

> 2. EN, Gharavi AK, Boey M, Patel BM, Mackworth-Young CG, Loizou

> S, GRV: Anticardiolipin antibodies: detection by radioimmunoassay

> and association with thrombosis in systemiclupus

> erythematosus. Lancet 2:1211-1214, 19833. Alarcon-Segovia D, Deleze M,

> Oria CV, -Guerrero J, Gomez-Pacheco L, Cabiedes J, Fernandez A,

> Ponce de Leon S: Antiphospholipid antibodies and the

> antiphospholipid syndrome in systemic lupus erythematosus: a prospective

> analysis of 500 consecutive patients. Medicine (Baltimore) 68:353-365,

> 19894. Asherson RA, Khamashta MA, Ordi-Ros J, Derksen RHWM,

> Machin SJ, Barquinero J, Out HH, EN, Vilarde- M,

> GRV: The primary antiphospholipid syndrome: major clinical and

> serological features. Medicine (Baltimore) 68:366374, 19895.

> Alarcon-Segovia

> D: Antiphospholipid syndrome within systemic lupus erythematosus.

> 3:289-291, 19946. Piette JC, Wechsler B. Frances C, Godeau P: Systemic

> lupus erythematosus and the antiphospholipid syndrome: reflections

> about the relevance of ARA criteria. J Rheumatol 19:1835-1837, 19927.

> EN, Gharavi AK, Patel BM, GRV: Evaluation of the

> anticardiolipin antibody test: report of an international workshop held

> 4 April

> 1986. Clin Exp Immunol 68:215-222, 1987 8.. EN, Phil M: The

> second international anticardiolipin standardization workshop: The

> Kingston Antiphospholipid Antibody Study (KAPS) Group. Am J Clin Pathol

> 94:474-484, 19909. Exner T, Triplett DA, Taberner D, Machin SJ:

> Guidelines fortesting and revised criteria for lupus anticoagulants:

> Subcommitteefor the Standardization of Lupus Anticoagulants. Thromb

> Haemost

> 65:320-322, 199110. Brandt JT, Triplett DA, Alving B. Scharrer I:

> Scientific and Standardization Committee Commumcations: criteria for the

> diagnosis of lupus anticoagulants-an update. Thromb Haemost

> 74:1185-1190, 1995

>

> Hochberg MC. Updating the American College of Rheumatology revised

> criteria for the classification of systemic lupus erythematosus

> [letter]. Arthritis Rheum 1997;40:1725.

> http://www.rheumatology.org/research/classification/1982SLEupdate.html

> From:

> SWEETCAROLINELV@...

>

> DIAGNOSIS:

>

> Because many

> lupus symptoms mimic other illnesses, are sometimes vague

> and may come

> and go, lupus can be difficult to diagnose. Diagnosis is usually

> made by a

> careful review of a person's entire medical history coupled with an

> analysis of

> the results obtained in routine laboratory tests and some specialized

> tests related

> to immune status. Currently, there is no single laboratory test

> that can

> determine whether a person has lupus or not. To assist the

> physician in

> the diagnosis of lupus, the American College of Rheumatology

> (ACR) in 1982

> issued a list of 11 symptoms or signs that help distinguish lupus

> from other

> diseases (see Table 2). This has recently been revised. A person

> should have

> four or more of these symptoms to suspect lupus. The symptoms

> do not all

> have to occur at the same time.

>

> Table 2

> The Eleven

> Criteria Used for the Diagnosis of Lupus

>

> Criterion

>

> Definition

> Malar

> Rash

>

> Rash over the cheeks

> Discoid

> Rash

>

> Red raised patches

>

> Photosensitivity

>

> Reaction to sunlight, resulting in the development of

>

> or increase in skin rash

> Oral

> Ulcers

>

> Ulcers in the nose or mouth, usually painless

>

> Arthritis

>

> Nonerosive arthritis involving two or more peripheral

>

> joints (arthritis in which the bones around the joints

>

> do not become destroyed)

>

> Serositis

>

> Pleuritis or pericarditis (inflammation of the lining of

>

> the lung or heart)

> Renal

> Disorder

>

> Excessive protein in the urine (greater than 0.5

>

> gm/day or 3+ on test sticks) and/or cellular casts

>

> (abnormal elements the urine, derived from red

>

> and/or white cells and/or kidney tubule cells)

>

> Neurologic

>

> Disorder

>

> Seizures (convulsions) and/or psychosis in the

>

> absence of drugs or metabolic disturbances which

>

> are known to cause such effects

>

> Hematologic

>

> Disorder

>

> Hemolytic anemia or leukopenia (white blood count

>

> below 4,000 cells per cubic millimeter) or

>

> lymphopenia (less than 1,500 lymphocytes per cubic

>

> millimeter) or thrombocytopenia (less than 100,000

>

> platelets per cubic millimeter). The leukopenia and

>

> lymphopenia must be detected on two or more

>

> occasions. The thrombocytopenia must be detected

>

> in the absence of drugs known to induce it.

>

> Antinuclear

>

> Antibody

>

> Positive test for antinuclear antibodies (ANA) in the

>

> absence of drugs known to induce it.

>

> Immunologic

>

> Disorder

>

> Positive anti-double stranded anti-DNA test, positive

>

> anti-Sm test, positive antiphospholipid antibody such

>

> as anticardiolipin, or false positive syphilis test

>

> (VDRL).

>

> http://www.lupus.org/education/diagnosis.html

> From:

> SWEETCAROLINELV@...

>

> I JUST SENT TWO EMAILS with the " UPDATE ON THE 1982 REVISED COLLEGE OF

> RHEUMATOLOGY CRITERIA FOR LUPUS DIAGNOSIS ---THIS WAS DONE IN 1995 AND

> ALL THE BIG LUPUS ORGANIZATIONS USE THE " UPDATED REVISED 82 CRITERIA "

> IT ONLY HAS THE CHANGE ABOUT THE ADDITION OF " ANTIPHOSPHIDAL

> --CARDIOLIPIN ANTIBODYS " -----THE OTHER EMAIL HAD THE NATIONAL LUPUS

> FOUNDATION SHOWING THEY USE THE SAME UPDATED CRITERIA AND ALSO THE

> " MERCK " LARGE MEDICAL SITE USES THE SAME CRITERIA THAT INCLUDES THE

> ANTIPHOSPHIDAL (please excuse the spelling --you know what i mean ) and

>

> the way it seems alot of us have that problem it DOES QUALIFY AS ONE OF

> THE CRITERIA THAT YOU NEED 4 OF THE 11 -----SO THIS COULD BE A REAL

> " STICKY POINT WITH DOW " ---BECAUSE THE LUPUS DIAGNOSIS DOES HAVE TO BE

>

> SOLID FROM A RHEMATOLOGIST AND SHOW AT LEAST 4 OF THE 11 CRITERIA ---IT

> COULD BE THE MOST IMPORTANT SYMPTOM YOU HAVE IF YOUR IN THE " LUPUS-LIKE

> ? " AREA -----ASK YOUR ATTORNEYS WHAT THIS " UPDATE " MEANS AND I FOR ONE

> DONT KNOW HOW DOW CAN " PICK AND CHOOSE WHAT CRITERIA TO RECOGNIZE " if

> the COLLEGE OF RHEUMATOLOGY HAS UPDATED AND CORRECTED ALL ITS CRITERIA

> AND THEY SHOW ALL THE DIFFERENT STUDIES AND DRS WHO SIGNED ON THE UPDATE

>

> ---- PRINT OUT THE WHOLE EMAIL AND SHOW YOUR LAWYER ---LETS SEE WHAT

> THEY DO ABOUT THIS ONE ? ----I knew when I saw that site that this was

> going to be a real zinger ----its LEGAL ---AND THEY SAY AS MUCH IN THEIR

>

> LETTER -----also ask your rheumatologist ----I KNOW THEY GOT MANY " DEAR

> DOCTOR " LETTERS FROM DOW AND OTHERS SAYING THAT NO SILICONE WOMEN HAVE

> LUPUS ---DUH ---AND BOY ARE WE MARKED WHEN IT COMES OUT ---THE DR ACTS

> LIKE HE SHOULD WEAR A GARLIC NECKLACE AROUND A SILICONE PATIENT ---LIKE

> WE HAVE FANGS AND SUCK BLOOD ---HUM I HAVE FELT LIKE THAT AT TIMES WITH

> DRS -----NA ----GOT ENOUGH TOXIC STUFF IN ME ------LUV CB

>

> --

> Finally, brethren, whatsoever things are true, whatsoever things are

> honest, whatsoever things are just, whatsoever things are pure,

> whatsoever

> things are lovely, whatsoever things are of good report; if there be any

>

> virtue, and if there be any praise, think on these things.

>

December 27, 2002