Lúpus eritematoso sistêmico
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
- Fenômeno de Raynaud
- telangiectasia
- livedo reticular
- vasculite
- 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
- sintomas neuropsiquiátricos
- disfagia
Risk factors
- sexo feminino
- idade >30 anos
- Afro-descendentes na Europa e nos EUA
- uso de determinados medicamentos
- exposição ao sol
- história familiar de LES
- tabagismo
- poluição do ar
- sílica cristalina livre
Diagnostic tests
1st tests to order
- hemograma completo com 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 (TC) do tórax
- testes de função pulmonar
- aspiração pleural
- ressonância nuclear magnética cranioencefálica
- ecocardiograma
- biópsia de pele
- biópsia renal
- hormônio estimulante da tireoide
Treatment algorithm
LES não renal: sintomas constitucionais ou manifestações articulares/serosite
LES não renal: manifestações mucocutâneas
LES renal (nefrite lúpica)
LES não renal: manifestações neuropsiquiátricas
LES não renal: manifestações hematológicas
Contributors
Authors
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
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.
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