New-Onset Rheumatologic Disease in an Elderly Patient Initially Presenting as Worsening Sequelae of Longstanding Peripheral Vascular Disease

Systemic lupus erythematosus (SLE) is an autoimmune disease that is believed to activate and attack nuclear antigens in genetically susceptible individuals after exposure to environmental factors causing cell damage. Although it is most common in females of child-bearing age, initial presentation is not strictly limited to this population, as onset over the age of 50 years is reported in 3-18% of cases. The common manifestations of SLE affect nearly every system of the body and may include arthralgia, myalgia, fever, rash, hepatosplenomegaly, lymphadenopathy, pleuritis, glomerulonephritis, pericarditis and neuropsychiatric manifestations. Common laboratory findings in SLE with varying degrees of sensitivity and specificity include anti-nuclear antibodies (ANA), anti-doublestranded DNA antibodies (anti-dsDNA), anti-histone antibodies, elevated inflammatory markers, and decreased levels of complements C3 and C4. 1 Treatment is typically aimed toward symptom management and prevention of organ damage; thus, treatment regimens are typically dictated by the organ systems involved and symptoms experienced.