When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Systemic lupus erythematosus

Last reviewed: 12 Nov 2024
Last updated: 05 Oct 2023

Summary

Definition

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
  • fibromyalgia
  • Raynaud phenomenon
  • 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
  • CNS signs: seizures, cranial nerve abnormalities, cognitive defects, psychosis
  • dysphagia
Full details

Risk factors

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

Diagnostic tests

1st tests to order

  • complete blood count and 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
  • 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
Full details

Treatment algorithm

ONGOING

joint symptoms and serositis

mucocutaneous disease

lupus nephritis

neuropsychiatric lupus

hematologic 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.

  • Systemic lupus erythematosus images
  • Differentials

    • Rheumatoid arthritis
    • Antiphospholipid syndrome
    • Systemic sclerosis
    More Differentials
  • Guidelines

    • Guideline for vaccinations in patients with rheumatic and musculoskeletal diseases
    • 2019 update of the Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of lupus nephritis
    More Guidelines
  • Patient information

    Systemic lupus erythematosus

    More Patient information
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    How to perform an ECG: animated demonstration

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer