Last reviewed: November 2017
Last updated: November  2017



History and exam

Key diagnostic factors

  • malar (butterfly) rash
  • photosensitive rash
  • discoid rash

Other diagnostic factors

  • fatigue
  • weight loss
  • fever
  • oral ulcers
  • alopecia
  • arthralgia/arthritis
  • fibromyalgia
  • Raynaud phenomenon
  • chest pain and shortness of breath
  • hypertension
  • signs of nephrosis (e.g., edema)
  • lymphadenopathy
  • venous or arterial thrombosis
  • abdominal pain, vomiting, or diarrhea
  • nose ulcers
  • poorly localized proximal limb inflammatory pain with weakness
  • dysrhythmias (e.g., tachycardia), conduction defects, or unexplained cardiomegaly
  • CNS signs: seizures, cranial nerve abnormalities, cognitive defects, psychosis
  • dysphagia

Risk factors

  • female gender
  • age 15 to 45 years
  • African/Asian descent in Europe and US
  • drugs
  • sun exposure
  • family history of SLE
  • tobacco smoking

Diagnostic investigations

1st investigations to order

  • CBC and differential
  • activated PTT
  • BUN and electrolytes
  • ESR and CRP
  • antinuclear antibodies, dsDNA, Smith antigen
  • urinalysis
  • chest x-ray
  • ECG
Full details

Investigations to consider

  • blood and urine cultures
  • antiphospholipid antibodies
  • Coombs test
  • 24-hour urine collection for protein or spot urine for protein/creatinine ratio
  • complement levels
  • creatine phosphokinase
  • plain x-rays of affected joint(s)
  • renal ultrasound
  • chest CT
  • pulmonary function tests
  • pleural aspiration
  • brain MRI
  • echocardiography
  • skin biopsy
  • renal biopsy
  • TSH
Full details

Treatment algorithm


Authors VIEW ALL

Consultant Rheumatologist

Wishaw General Hospital




MMC declares that she has no competing interests.

Consultant Physician and Rheumatologist

Department of Rheumatology

Glasgow Royal Infirmary




RM holds shares in GSK to the value less than £12,000.

Dr Meng May Chee and Dr Rajan Madhok would like to gratefully acknowledge Dr Gayle McKellar, a previous contributor to this monograph. GM declares that she has no competing interests.

Peer reviewers VIEW ALL

Associate Director

Medical University of South Carolina




JCO declares that he has no competing interests.

Professor of Medicine

University of Texas Southwestern Medical Center




NJO declares that she has no competing interests.

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