Systemic lupus erythematosus

Last reviewed: 2 Sep 2022
Last updated: 23 Feb 2022

Summary

Definition

History and exam

Key diagnostic factors

  • malar (butterfly) rash
  • photosensitive rash
  • discoid rash
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • female sex
  • age >30 years
  • African descent in Europe and US
  • drugs
  • sun exposure
  • family history of SLE
  • tobacco smoking
More risk factors

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
More 1st investigations to order

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
More investigations to consider

Treatment algorithm

ONGOING

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.

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  • Guidelines

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