Last reviewed: March 2019
Last updated: August  2018

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

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
Full details

Diagnostic investigations

1st investigations to order

  • CBC and differential
  • activated PTT
  • BUN and electrolytes
  • erythrocyte sedimentation rate (ESR) and CRP
  • antinuclear antibodies, double-stranded (ds) DNA, Smith antigen
  • urinalysis
  • chest x-ray
  • ECG
Full details

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)
Full details

Treatment algorithm

ONGOING

joint symptoms and serositis

mucocutaneous disease

lupus nephritis

neuropsychiatric lupus

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 topic. 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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