Summary
Definition
History and exam
Other diagnostic factors
- fatigue
- weight loss
- fever
- oral ulcers
- alopecia
- arthralgia/arthritis
- fibromyalgia
- Raynaud phenomenon
- chest pain and shortness of breath
- hypertension
- signs of nephrosis (e.g., edema)
- lymphadenopathy
- venous or arterial thrombosis
- abdominal pain, vomiting, or diarrhea
- nose ulcers
- poorly localized 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 gender
- 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
- CBC and differential
- activated PTT
- BUN and electrolytes
- ESR and CRP
- antinuclear antibodies, dsDNA, 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
- TSH
Treatment algorithm
Contributors
Authors VIEW ALL
Consultant Rheumatologist
Wishaw General Hospital
Wishaw
UK
Disclosures
MMC declares that she has no competing interests.
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.
Dr Meng May Chee and Dr Rajan Madhok would like to gratefully acknowledge Dr Gayle McKellar, a previous contributor to this monograph. GM declares that she has no competing interests.
Peer reviewers VIEW ALL
Associate Director
Medical University of South Carolina
Charleston
SC
Disclosures
JCO declares that he has no competing interests.
Professor of Medicine
University of Texas Southwestern Medical Center
Dallas
TX
Disclosures
NJO declares that she has no competing interests.
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