Last reviewed: 1 Nov 2021
Last updated: 13 Dec 2019

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
  • central nervous system (CNS) signs: seizures, cranial nerve abnormalities, cognitive defects, psychosis
  • dysphagia

Risk factors

  • female sex
  • 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

  • FBC and differential
  • activated PTT
  • urea and electrolytes
  • erythrocyte sedimentation rate (ESR) and CRP
  • 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 CT
  • pulmonary function tests
  • pleural aspiration
  • brain MRI
  • echocardiography
  • skin biopsy
  • renal biopsy
  • thyroid-stimulating hormone (TSH)

Treatment algorithm

Contributors

Authors

Meng May Chee, MBChB, MRCP

Consultant Rheumatologist

Wishaw General Hospital

Wishaw

UK

Disclosures

MMC declares that she has no competing interests.

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.

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