Hypertensive disorders of pregnancy: Differentiating preeclampsia from active systemic lupus erythematosus

The diagnosis of preeclampsia is made on the basis of hypertension, proteinuria and edema. Unfortunately, all three of these findings can be seen in the patient who is experiencing a flare of systemic lupus erythematosus. The management of these conditions is entirely different. Preeclampsia frequently results in the need for delivery and occasionally, especially when remote from term, can result in significant neonatal morbidity and mortality. Systemic lupus may be treatable with a variety of pharmacologic agents. It is not always possible to make the distinction between active lupus and preeclampsia, and occasionally the two occur concurrently. Nevertheless, the goal of the rheumatologist and perinatologist is to try to make that distinction. Physical findings and serologic markers can be useful in helping to distinguish between these two diagnoses. Under certain circumstances, delivery is indicated despite the presence of continued uncErtainty as to the actual diagnosis.