Systemic lupus erythematosus

Keywords: SLE

Presentation

Appropriate Tests

 

Diagnosis is based on defined clinical and pathological criteria which include positive Antinuclear Ab and/or positive antibodies to double stranded DNA and anti nucleosome antibodies

Rheumatoid factor and Extractable nuclear antigen Ab (especially the presence of Sm Antibody) assist to differentiate SLE from other systemic rheumatic diseases.

Disease activity may be monitored by Full blood count, Erythrocyte sedimentation rate, and in some patients Complement components C3 and C4 and levels of double stranded DNA Ab.

Creatinine, Urea, Aspartate aminotransferase, Alanine aminotransferase and C-Reactive protein may assist to define the extent of disease and complications; Lupus anticoagulant and Cardiolipin Ab may also predict complications of disease.

Systemic features

Fever

Malaise

Weight loss

 

Musculoskeletal

Arthritis - polyarticular

Myalgia

Myopathy

 

Skin and mucous membranes

Rash, especially

  • Vasculitis
  • Alopecia
  • Oral ulcers
  • Raynaud's phenomenon

Lupus band test - skin, may be useful to differentiate between discoid and systemic lupus

 

 

 


See under Cold related disorders

Renal

Glomerulonephritis

Nephrotic syndrome

Renal biopsy, if indicated.

Haematological

Autoimmune haemolysis

Neutropenia

Lymphocytopenia

Thrombocytopenia

Thrombosis

 

Direct antiglobulin test.

See Haemolysis

 

 

 

APTT, Lupus anticoagulant, Cardiolipin Ab, Beta-2 glycoprotein 1 Ab.

Coagulation factor inhibitor

APTT, Prothrombin time, Coagulation factor inhibitors.

Abortion - habitual

Antiphospholipid antibody syndrome.

Cardiopulmonary

Pericarditis

Myocarditis

Endocarditis

Pleurisy

 

Interstitial lung disease

 

Neurological

Organic brain syndrome

  • Psychiatric disturbance
  • Convulsions

Stroke (cerebral thrombosis)

Neuropathy

 

No pathology test reliably detects risk.

 


APTT, Lupus anticoagulant; Cardiolipin Ab, Beta-2 glycoprotein 1 Ab.

Drug induced lupus, due to

 
  • Hydralazine
  • Procainamide
  • Isoniazid