Summary
Definition
History and exam
Key diagnostic factors
- erupção cutânea malar (em asa de borboleta)
- erupção cutânea fotossensível
- erupção cutânea discoide
Other diagnostic factors
- fadiga
- perda de peso
- febre
- úlceras orais
- alopécia
- artralgia/artrite
- fibromialgia
- Fenômeno de Raynaud
- dor torácica e dispneia
- trombose venosa ou arterial
- hipertensão
- sinais de nefrose (por exemplo, edema)
- linfadenopatia
- dor abdominal, vômitos ou diarreia
- úlceras nasais
- dor inflamatória de localização inespecífica dos membros proximais com fraqueza
- disritmias (por exemplo, taquicardia), defeitos de condução ou cardiomegalia não explicada
- Sinais no SNC: convulsões, anormalidades do nervo craniano, deficiências cognitivas, psicose
- disfagia
Risk factors
- sexo feminino
- idade >30 anos
- Afro-descendentes na Europa e nos EUA
- medicamentos
- exposição ao sol
- história familiar de LES
- tabagismo
Diagnostic tests
1st tests to order
- hemograma completo e diferencial
- tempo de tromboplastina parcial ativada
- ureia e eletrólitos
- velocidade de hemossedimentação e proteína C-reativa
- fatores antinucleares, DNA de fita dupla (ds), antígeno Smith
- urinálise
- radiografia torácica
- eletrocardiograma (ECG)
Tests to consider
- hemocultura e cultura de urina
- anticorpos antifosfolipídeos
- teste de Coombs
- coleta de urina de 24 horas para proteína ou o teste da proporção proteína/creatinina urinária
- níveis do complemento
- creatina fosfoquinase
- radiografia simples das articulações afetadas
- ultrassonografia renal
- tomografia computadorizada do tórax
- testes de função pulmonar
- aspiração pleural
- ressonância nuclear magnética cranioencefálica
- ecocardiografia
- biópsia de pele
- biópsia renal
- hormônio estimulante da tireoide
Treatment algorithm
sintomas articulares e serosite
doença mucocutânea
nefrite lúpica
lúpus neuropsiquiátrico
manifestações hematológicas
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.
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
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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