toes; pain, swelling in digits Ocular Blurring or loss of vision, headache Funduscopic examination CT scan Traverse myelitis Paraplegia, CT, MRI, LP (once paraparesis, pain, epidural abscess sensory level excluded), antiphospholipid antibody, lupus anticoagulant analgesia, prednisone Calcium-channel blockers Sympathetic ganglion block Lumbar puncture (caution), prednisone Pulse dose methylprednisolone, cytotoxic agents, anticoagulation a Treatment regimens (except for infectious category) assume that an infectious etiology has been excluded CBC, complete blood count; ESR, erythrocyte sedimentation rate; CSF, cerebrospinal fluid; BUN, blood urea nitrogen; PO, orally; IV, intravenously; EEG, encephalogram; MRI, magnetic resonance imaging; CT, computed tomography; ICU, intensive care unit; ANA, antinuclear antibody; NPO, nothing by mouth; NG, nasogastric; EKG, electrocardiogram; NSAIDs, nonsteroidal anti-inflammatory drugs; LP, lumbar puncture Renal Complications Renal disease is a major cause of morbidity in SLE, so it is important to establish its presence and severity at the time of diagnosis, and to regularly monitor renal function thereafter Clinical manifestations of lupus nephritis are often minimal Signs of nephrotic syndrome or acute renal failure require a more thorough investigation that should include estimation of the protein in a 24-hour urine collection; creatinine clearance; measurement of C3, ANA, and anti-ds DNA antibodies; and renal biopsy In a patient with SLE and documented renal disease, hospitalization is necessary in the presence of rapidly worsening renal status, hypertensive crisis, or severe complications of therapy Treatment is aimed at preserving renal function while minimizing medication toxicity Selection of therapeutic agents depends on biopsy results and classification of renal involvement according to the World Health Organization classification, available at http://www.wolterskluwerindia.co.in/rheumatology/Rheumatology-Issue35.html Active disease often may be managed with pharmacologic doses of corticosteroids (prednisone to mg/kg/day) In the presence of progressive renal failure, the patient should be hospitalized for more aggressive therapy with IV corticosteroids with or without other immunosuppressive agents “Pulse” therapy with methylprednisolone (30 mg/kg, 1,500 mg maximum) may be indicated in the presence of rapidly progressive renal disease The combination of cyclophosphamide and rituximab, as well as the oral agent mycophenolate mofetil, has also shown promise in the treatment of lupus