Generalised disorder that can affect any system.
Symptoms and signs may accumulate over time.
The diagnosis is made using criteria recommended by the American College of Rheumatology.
Treatments for mild to moderate serositis or arthritis include hydroxychloroquine, non-steroidal anti-inflammatory drugs, or corticosteroids. Treatments for more severe disease may include cyclophosphamide, mycophenolate, or tacrolimus plus corticosteroids.
Systemic lupus erythematosus (SLE) is a chronic multi-system disorder that most commonly affects women during their reproductive years. It is characterised by the presence of antinuclear antibodies. In addition to constitutional symptoms, it most frequently involves the skin and joints, although serositis, nephritis, haematological cytopenias, and neurological manifestations may occur during the course of the disease. Earlier diagnosis and better management have resulted in a lower prevalence of life-threatening disease.
History and exam
- weight loss
- oral ulcers
- Raynaud's phenomenon
- chest pain and shortness of breath
- venous or arterial thrombosis
- signs of nephrosis (e.g., oedema)
- abdominal pain, vomiting, or diarrhoea
- nose ulcers
- poorly localised proximal limb inflammatory pain with weakness
- dysrhythmias (e.g., tachycardia), conduction defects, or unexplained cardiomegaly
- central nervous system (CNS) signs: seizures, cranial nerve abnormalities, cognitive defects, psychosis
- 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
- skin biopsy
- renal biopsy
- thyroid-stimulating hormone (TSH)
Meng May Chee, MBChB, MRCP
Wishaw General Hospital
MMC declares that she has no competing interests.
Rajan Madhok, MD, FRCP(Glasg)
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 topic.
GM declares that she has no competing interests.
James C. Oates, MD
Medical University of South Carolina
JCO declares that he has no competing interests.
Nancy J. Olsen, MD, PhD
Professor of Medicine
University of Texas Southwestern Medical Center
NJO declares that she has no competing interests.
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