Sites on systemic lupus erythematosus

Websites relating to this week's Clinical Review selected by Dr Keith Barnard

WEBSITE OF THE WEEK

I usually keep it simple for the Website of the Week, but this week I have chosen a site that is a little more challenging.

It concerns the neurological complications of systemic lupus erythematosus (SLE). These problems are more common than one might think. The prevalence of nervous system involvement in SLE patients ranges from 14 per cent to over 90 per cent, depending on the severity and type of symptoms considered.

Patients can present with seizures, stroke, and altered mental status, including coma, psychosis, dementia, and chorea. Headaches, paraesthesias, anxiety states, cognitive difficulties and other less specific symptoms may also occur.

This site discusses these possibilities. What enhances it are the images — mostly MRI scans, but also some coloured slides — that demonstrate the underlying pathology.

The third and fourth links on the title page are the most useful.Some interesting case histories are described here. These include a fatal encephalopathy in a 22-year-old woman, and a fatal hypertensive haemorrhage in a young woman with SLE who presented at 31 weeks gestation with seizures and a systolic BP over 200mmHg.

These situations are out there, and we should be aware of them.

Why go there: interesting and relevant.

Downside: we don’t need to know the technical stuff.

Information from: American Society of Neuroradiology.

MANAGEMENT OF SLE

This offering is much better than it looks — I do wish this online journal would abandon its format of a long narrow column down the centre of the screen. In the meantime, before reading this article, I advise you to cut and paste the whole feature into a Word or other word-processing file. You will then end up with a much more readable four-and-a-half pages of text, instead of having to scroll down seemingly endless screens.

This website is packed with information that will prove useful to GP registrars, trainers, and those GPs who need to brush up on their knowledge.

Management of this condition is difficult. There are no miracle cures. As the wise words at the end of the article put it, ‘The physician’s goal is to diminish morbidity and mortality due to SLE and to preserve the patient’s quality of life.’

Why go there: a detailed overview.

Downside: no images.

Information from: Postgraduate Medicine online.

PATIENT INFORMATION

These web pages give an excellent account of SLE for patients. At first I thought it was overly long, but this is a complex condition with so many facets that it is difficult to cover it in a few paragraphs.

This presentation is described as a booklet, but is in fact one long, continuous, rather narrow column that could be presented better. The coloured line drawings, however, are first class.

The account starts with a discussion about the fact that some patients complain that the booklet does not emphasise the serious nature of the disease, while others complain equally strongly that it makes SLE appear worse than it actually is.

However, this is one of the dilemmas that face patients and their GPs. While for some, SLE represents not much more than a nuisance, for others the disease greatly disrupts their existence and can even be life-threatening.

Why go there: can be recommended wholeheartedly.

Downside: no printer-friendly version.

Information from: Arthritis Research Campaign.

NOW SHOW THE PC YOUR TONGUE

I think most doctors will have agreed with me when I said earlier that there is no miracle cure for SLE. However, I just knew someone would claim to be able to make patients better and symptom-free — and therefore I was not surprised by the bold statements on this website.

Although the advertiser claims this nine-herb mixture is to be used alongside conventional treatment, it still claims that patients are actually ‘healed’ by its product. It also claims it is low-cost, but $700 plus shipping does not seem to be at the low end of the scale to me.

You then have to fill in one of the longest questionnaires I think I have ever seen.

But do take time to scroll down to the last screen. Here you are asked to choose which of 14 tongues that are poked out at you resembles yours. If your tongue does not match any of the images, then you have to describe its appearance to the computer. Or, if this is too difficult for you, you have an option to send them an image of your tongue. Funny? Yes. Risky? Possibly. A waste of $700? Surely.

Downside: where is the science?

Information from: HerbChina 2000.

Dr Barnard is a former GP in Fareham, Hampshire

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