Systemic lupus erythematosus
Summary
Definition
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's phenomenon
- chest pain and shortness of breath
- venous or arterial thrombosis
- hypertension
- signs of nephrosis (e.g., oedema)
- lymphadenopathy
- abdominal pain, vomiting, or diarrhoea
- nose ulcers
- poorly localised 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 sex
- age >30 years
- African descent in Europe and US
- drugs
- sun exposure
- family history of SLE
- tobacco smoking
Diagnostic investigations
1st investigations to order
- full blood count and differential
- activated partial thromboplastin time
- urea and electrolytes
- erythrocyte sedimentation rate and C-reactive protein
- antinuclear antibodies, double-stranded (ds)DNA, Smith antigen
- urinalysis
- chest x-ray
- ECG
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 computed tomography
- pulmonary function tests
- pleural aspiration
- brain magnetic resonance imaging
- echocardiography
- skin biopsy
- renal biopsy
- thyroid-stimulating hormone
Treatment algorithm
joint symptoms and serositis
mucocutaneous disease
lupus nephritis
neuropsychiatric lupus
haematological manifestations
Contributors
Authors
Meng May Chee, MBChB, MRCP
Consultant Rheumatologist
Queen Elizabeth University Hospital
Glasgow
UK
Disclosures
MMC was sponsored by Abbvie to attend the European League Against Rheumatism 2020 online conference.
Rajan Madhok, MD, FRCP(Glasg)
Consultant Physician and Rheumatologist
Department of Rheumatology
Glasgow Royal Infirmary
Glasgow
UK
Disclosures
RM holds shares in GSK to the value less than £12,000.
Acknowledgements
Dr Meng May Chee and Dr Rajan Madhok would like to gratefully acknowledge Dr Gayle McKellar, a previous contributor to this topic.
Disclosures
GM declares that she has no competing interests.
Peer reviewers
James C. Oates, MD
Associate Director
Medical University of South Carolina
Charleston
SC
Disclosures
JCO declares that he has no competing interests.
Nancy J. Olsen, MD, PhD
Professor of Medicine
University of Texas Southwestern Medical Center
Dallas
TX
Disclosures
NJO declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Rheumatoid arthritis
- Antiphospholipid syndrome
- Systemic sclerosis
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