Systemic lupus erythematosus

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 20 Oct 2025

Last updated: 13 Nov 2025

Systemic lupus erythematosus (SLE) is a generalized disorder that can affect any system.

Symptoms and organ damage may accumulate over time.

SLE is diagnosed clinically.

Treatment of SLE requires multidisciplinary, individualized management including patient education as well as nonpharmacologic interventions.

Pharmacologic treatments include hydroxychloroquine, corticosteroids, immunosuppressants, and biologic agents (e.g., belimumab, anifrolumab), often used in combination with each other. Specific treatment is determined by the patient’s symptoms, the organs affected, and the severity of disease.

Definition

SLE is a chronic multisystem disorder that most commonly affects women during their reproductive years. It is characterized by the presence of antinuclear antibodies. In addition to constitutional symptoms and signs, SLE most frequently involves the skin and joints, although serositis, nephritis, hematologic cytopenias, and neurologic 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

Key diagnostic factors

malar (butterfly) rash
photosensitive rash
discoid rash

Full details

Other diagnostic factors

fatigue
weight loss
fever
oral ulcers
alopecia
arthralgia/arthritis
Raynaud phenomenon
telangiectasia
livedo reticularis
vasculitis
chest pain and shortness of breath
venous or arterial thrombosis
hypertension
signs of nephrosis (e.g., edema)
lymphadenopathy
abdominal pain, vomiting, or diarrhea
nose ulcers
poorly localized proximal limb inflammatory pain with weakness
dysrhythmias (e.g., tachycardia), conduction defects, or unexplained cardiomegaly
neuropsychiatric symptoms
dysphagia

Full details

Risk factors

female sex
age >30 years
African descent in Europe and US
use of certain drugs
sun exposure
family history of SLE
tobacco smoking
air pollution
free crystalline silica

Full details

Diagnostic tests

1st tests to order

complete blood count with differential
activated partial thromboplastin time
BUN and electrolytes
erythrocyte sedimentation rate and C-reactive protein
antinuclear antibodies, double-stranded (ds)DNA, Smith antigen
urinalysis
chest x-ray
ECG

Full details

Tests 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
creatinine phosphokinase
plain x-rays of affected joint(s)
renal ultrasound
CT chest
pulmonary function tests
pleural aspiration
brain magnetic resonance imaging
echocardiogram
skin biopsy
kidney biopsy
thyroid-stimulating hormone

Full details

Treatment algorithm

ONGOING

nonrenal SLE: constitutional symptoms or joint manifestations/serositis

nonrenal SLE: mucocutaneous manifestations

renal SLE (lupus nephritis)

nonrenal SLE: neuropsychiatric manifestations

nonrenal SLE: hematologic manifestations

Contributors

Authors

Jacob J. E. Koopman, MD PhD

Medical Specialist in Clinical Immunology

Internal Medicine

Erasmus Medical Center

Rotterdam

Netherlands

Disclosures

JJEK is a member of the editorial board for the Dutch Journal of Allergy, Asthma and Clinical Immunology. He has received research grants from SLEuro, European Alliance of Associations for Rheumatology, American College of Rheumatology, Erasmus Trust Fund and NVLE, and has also acted as an unpaid subinvestigator as a medical specialist for clinical trials which were sponsored by UMC Utrecht, GlaxoSmithKline, Nierstichling Nederland, Aurinia Pharmaceuticals and Biogen.

Acknowledgements

Dr Jacob Koopman would like to gratefully acknowledge Dr Meng May Chee, Dr Rajan Madhok, and Dr Gayle McKellar, as previous contributors to this topic.

Disclosures

MMC was sponsored by Abbvie to attend the European League Against Rheumatism 2020 online conference. RM holds shares in GSK to the value less than £12,000. GM declares that she has no competing interests.

Peer reviewers

James C. Oates, MD

Associate Director

Medical University of South Carolina

Charleston

Disclosures

JCO declares that he has no competing interests.

Nancy J. Olsen, MD, PhD

Professor of Medicine

University of Texas Southwestern Medical Center

Dallas

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Fanouriakis A, Kostopoulou M, Andersen J, et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis. 2024 Jan 2;83(1):15-29.Full text Abstract

Sammaritano LR, Askanase A, Bermas BL, et al. 2024 American College of Rheumatology (ACR) guideline for the screening, treatment, and management of lupus nephritis. Arthritis Rheumatol. 2025 Sep;77(9):1115-35.Full text Abstract

Kidney Disease: Improving Global Outcomes (KDIGO) Lupus Nephritis Work Group. KDIGO 2024 clinical practice guideline for the management of LUPUS NEPHRITIS. Kidney Int. 2024 Jan;105(1s):S1-69.Full text Abstract

Parodis I, Girard-Guyonvarc'h C, Arnaud L, et al. EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. Ann Rheum Dis. 2024 May 15;83(6):720-9.Full text Abstract

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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Guidelines
- American College of Rheumatology guidelines for the screening, treatment, and management of lupus nephritis
- American College of Rheumatology guidance statements for addressing mental health concerns in youth with pediatric rheumatologic diseases
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Patient information
Systemic lupus erythematosus
More Patient information
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Systemic lupus erythematosus

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

nonrenal SLE: constitutional symptoms or joint manifestations/serositis

nonrenal SLE: mucocutaneous manifestations

renal SLE (lupus nephritis)

nonrenal SLE: neuropsychiatric manifestations

nonrenal SLE: hematologic manifestations

Contributors

Authors

Jacob J. E. Koopman, MD PhD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

James C. Oates, MD

Disclosures

Nancy J. Olsen, MD, PhD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice