Systemic Lupus Erythematosus History taking: 1.

General features - Fever during flare (50%) - Malaise, tiredness (due to anemia) - Loss of weight - Gain weight (due to steroid) 2. Joints and muscles - symmetrical small joint athralgiaRA like (>90%) - myalgia (50%) 3. Skin - Rash (75%): face, sun-exposed areas, photosensitivity - Urticaria - Alopecia 4. Lungs (50%) - SOB or chest pain due to pleuritic pain 5. Haematological - Purpura, bleeding from gums, excessive menstrual bleeding (due to thrombocytopenia) 6. Kidneys (30%) - hypertension, oedema 7. Nervous system (60%) - Seizures, psychosis, migraine, depression, epilepsy 8. Eyes - visual acuity 9. GIT - Painless mouth ulcers (1/3) 10. history of remissions and exacerbations 11. drug history: hydralazine (vasodilator to treat HTN), procainamide (antiarrhythmic agent) 12. Family history 13. Family planning Physical Examination: 1. General inspection: a. Weight loss (due to chronic inflammation) b. Cushiongoid appearance (due to steroid treatment) 2. Hands: a. Vasculitis around the nail bed, esp. telangiectasia, erythema of the skin of the nail bed, splinter hemorrhages, periungual infarcts b. Raynauds phenomenon (whitebluered) c. Rash d. Palmar erythema e. Symmetrical small joint arthritis 3. Arms: a. Livedo reticularis (connected bluish-purple streaks w/o discrete borders)

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b. Purpura (due to vasculitis or thrombocytopenia) c. Proximal myopathy (due to disease or steroid) d. Rash (photosensitivity) e. Scratch marks Head and neck: a. Alopecia (2/3 of patients) b. Conjunctival pallor c. Conjunctivitis, scleritis, episcleritis d. Butterfly rash: fixed erythema, flat or raised, over the malar eminences sparing the nasolabial folds a/w follicular plugging, scales, telangiectasia and scarring e. Discoid rash: Erythematous raised patches with adherent keratotic scales and follicular plugging and atrophic scarring. Affects the ears, cheeks, scalp, forehead and chest: erythemapigmented hyperkeratotic oedematous papulesatrophic depression lesions f. Mouth ulcers g. Non-tender cervical lymphadenopathy Chest a. Pericardial rub (due to pericarditis) b. Pleural rub (due to pleuritis), pleural effusion, pulmonary fibrosis, pulmonary collapse, pulmonary HTN Abdomen a. Splenomegaly Legs a. Peripheral neuropathy b. Ankle oedema (due to nephrotic syndrome) Offer to a. Perform a urine analysis (for proteinuria and haematuria) b. Take the blood pressure (for HTN) c. Take the temperature

Investigations: 1. Full blood count: leucopenia, lymphopenia, thrombocytopenia, autoimmue haemolytic anemia, *raised ESR, normal CRP 2. Serum antinuclear antibodies (ANA): positive in almost all cases 3. *Serum anti-dsDNA antibodies 4. Rheumatoid factor may be positive 5. *Complement: low C3 and C4 *Best for monitoring activity of disease Management: 1. avoid sunlight, use sun block 2. avoid provoking drug e.g. penicillin 3. educate the patient that no therapy is curative 4. Symptomatic treatment: a. NSAIDs for joint or skin symptoms b. Low dose steroids for malaise, LOW and lymphadenopathy c. High-dose prednisolone for flare d. Immunosuppressive drugs for severe disease