Systemic lupus erythematosus

Last reviewed: 24 Aug 2023
Last updated: 02 Nov 2022



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 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
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

  • 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
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


joint symptoms and serositis

mucocutaneous disease

lupus nephritis

neuropsychiatric lupus

hematologic manifestations



Meng May Chee, MBChB, MRCP

Consultant Rheumatologist

Queen Elizabeth University Hospital




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




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

James C. Oates, MD

Associate Director

Medical University of South Carolina




JCO declares that he has no competing interests.

Nancy J. Olsen, MD, PhD

Professor of Medicine

University of Texas Southwestern Medical Center




NJO declares that she has no competing interests.

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