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Systemic lupus erythematosus

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  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 30 Nov 2025
最后更新： 13 Nov 2025

小结

定义

病史和体格检查

关键诊断因素

  • malar (butterfly) rash
  • photosensitive rash
  • discoid rash
完整详情

其他诊断因素

  • fatigue
  • weight loss
  • fever
  • oral ulcers
  • alopecia
  • arthralgia/arthritis
  • Raynaud phenomenon
  • telangiectasia
  • livedo reticularis
  • vasculitis
  • 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
  • neuropsychiatric symptoms
  • dysphagia
完整详情

危险因素

  • female sex
  • age >30 years
  • African descent in Europe and US
  • use of certain drugs
  • sun exposure
  • family history of SLE
  • tobacco smoking
  • air pollution
  • free crystalline silica
完整详情

诊断性检查

首要检查

  • complete blood count with 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
完整详情

需考虑的检查

  • blood and urine cultures
  • antiphospholipid antibodies
  • Coombs test
  • 24-hour urine collection for protein or spot urine for protein/creatinine ratio
  • complement levels
  • creatinine phosphokinase
  • plain x-rays of affected joint(s)
  • renal ultrasound
  • CT chest
  • pulmonary function tests
  • pleural aspiration
  • brain magnetic resonance imaging
  • echocardiogram
  • skin biopsy
  • kidney biopsy
  • thyroid-stimulating hormone
完整详情

治疗流程

持续性治疗

nonrenal SLE: constitutional symptoms or joint manifestations/serositis

nonrenal SLE: mucocutaneous manifestations

renal SLE (lupus nephritis)

nonrenal SLE: neuropsychiatric manifestations

nonrenal SLE: hematologic manifestations

撰稿人

作者

Jacob J. E. Koopman, MD PhD

Medical Specialist in Clinical Immunology

Internal Medicine

Erasmus Medical Center

Rotterdam

Netherlands

Disclosures

JJEK is a member of the editorial board for the Dutch Journal of Allergy, Asthma and Clinical Immunology. He has received research grants from SLEuro, European Alliance of Associations for Rheumatology, American College of Rheumatology, Erasmus Trust Fund and NVLE, and has also acted as an unpaid subinvestigator as a medical specialist for clinical trials which were sponsored by UMC Utrecht, GlaxoSmithKline, Nierstichling Nederland, Aurinia Pharmaceuticals and Biogen.

Acknowledgements

Dr Jacob Koopman would like to gratefully acknowledge Dr Meng May Chee, Dr Rajan Madhok, and Dr Gayle McKellar, as previous contributors to this topic.

Disclosures

MMC was sponsored by Abbvie to attend the European League Against Rheumatism 2020 online conference. RM holds shares in GSK to the value less than £12,000. 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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Fanouriakis A, Kostopoulou M, Andersen J, et al. EULAR recommendations for the management of systemic lupus erythematosus: 2023 update. Ann Rheum Dis. 2024 Jan 2;83(1):15-29.Full text  Abstract

Sammaritano LR, Askanase A, Bermas BL, et al. 2024 American College of Rheumatology (ACR) guideline for the screening, treatment, and management of lupus nephritis. Arthritis Rheumatol. 2025 Sep;77(9):1115-35.Full text  Abstract

Kidney Disease: Improving Global Outcomes (KDIGO) Lupus Nephritis Work Group. KDIGO 2024 clinical practice guideline for the management of LUPUS NEPHRITIS. Kidney Int. 2024 Jan;105(1s):S1-69.Full text  Abstract

Parodis I, Girard-Guyonvarc'h C, Arnaud L, et al. EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. Ann Rheum Dis. 2024 May 15;83(6):720-9.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Systemic lupus erythematosus images

  • Differentials

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  • Guidelines

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    • American College of Rheumatology guidance statements for addressing mental health concerns in youth with pediatric rheumatologic diseases
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  • Patient information

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