Systemic lupus erythematosus is a chronic autoimmune disease in which antibodies and immune complexes inflame many organs, including the skin, joints, kidneys, blood and brain. It mostly affects women of childbearing age and runs in flares and remissions.
Key symptoms
- Fatigue, fever and weight loss
- Joint pain and swelling in the hands and wrists
- Butterfly rash on the cheeks, worse with sun
- Mouth ulcers, hair loss, chest pain on breathing
What you find on exam
- Malar rash sparing the nasolabial folds; discoid lesions
- Painless oral ulcers
- Joint swelling without erosive deformity
- Edema, high blood pressure, pericardial or pleural rub
Tests
- ANA as the screening test; anti-dsDNA and anti-Smith are specific
- Complement C3 and C4 low in active disease
- Blood count for anemia and low white cells or platelets
- Urinalysis and urine protein-to-creatinine ratio for kidney disease
Treatment basics
- Hydroxychloroquine for nearly all patients
- Sun protection, NSAIDs for joint pain, short glucocorticoid courses for flares
- Immune suppression for organ disease: mycophenolate, azathioprine, belimumab or cyclophosphamide
- Screening for heart disease, bone loss and infections, plus pregnancy planning
Red flags
- Swelling, foamy urine or rising creatinine from lupus nephritis
- Seizures, psychosis or stroke symptoms
- Fever on immune suppression, chest pain or shortness of breath
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.