Clinical Features
SLE is known as “the disease with a thousand faces” due to its wide
spectrum of manifestations.
1. Constitutional Symptoms
• Fatigue
• Fever
• Weight loss
• Malaise
2. Musculoskeletal System
• Symmetrical, non-erosive arthritis
• Commonly involves small joints
• Myalgia and muscle weakness
3. Cutaneous Manifestations
• Malar (butterfly) rash
• Photosensitivity
• Discoid rash
• Oral and nasal ulcers
• Alopecia
• Livedo reticularis
4. Renal Involvement (Lupus Nephritis)
• Proteinuria
• Hematuria
• Hypertension
• Edema
• Can progress to renal failure
• Classified into six classes based on renal biopsy (ISN/RPS
classification)
5. Hematological Manifestations
• Anemia (often hemolytic)
• Leukopenia
• Lymphopenia
• Thrombocytopenia
6. Cardiovascular System
6. Cardiovascular System
• Pericarditis (most common)
• Myocarditis
• Libman–Sacks endocarditis
• Accelerated atherosclerosis
7. Respiratory System
• Pleuritis
• Pleural effusion
• Interstitial lung disease
• Pulmonary hypertension
8. Neuropsychiatric Lupus
• Seizures
• Psychosis
• Cognitive dysfunction
• Headache
• Stroke
9. Gastrointestinal and Other Systems
• Vasculitis
• Mesenteric ischemia
• Pancreatitis
Investigations
Laboratory Findings
Hematological
• Anemia
• Leukopenia
• Thrombocytopenia
• Raised ESR (CRP often normal unless
infection)
Immunological Tests
• ANA (positive in >95% cases)
• Anti-dsDNA (disease activity marker)
• Anti-Sm (highly specific)
• Antiphospholipid antibodies
• Low complement levels (C3, C4)
Renal Tests
• Urinalysis (proteinuria, casts)
• Serum creatinine
• Renal biopsy if indicated
Diagnostic Criteria
ACR / EULAR Criteria
Diagnosis is based on a combination of:
• Clinical features
• Immunological markers
A weighted scoring system is used, with ANA
positivity as an entry criterion.
Differential Diagnosis
• Rheumatoid arthritis
• Dermatomyositis
• Systemic sclerosis
• Mixed connective tissue disease
• Vasculitis
• Antiphospholipid antibody syndrome
Management
There is no cure for SLE, but disease control is possible with
appropriate therapy.
General Measures
• Patient education
• Sun protection
• Regular follow-up
• Vaccinations
Pharmacological Treatment
1. NSAIDs
• For mild arthritis and serositis
2. Antimalarials
• Hydroxychloroquine (cornerstone therapy)
• Reduces flares and improves survival
3. Corticosteroids
• Used for moderate to severe disease
• Oral or intravenous depending on severity
4. Immunosuppressive Agents
• Azathioprine
• Methotrexate
• Mycophenolate mofetil
• Cyclophosphamide (for severe lupus nephritis)
5. Biologic Therapy
• Belimumab
• Rituximab (off-label in refractory cases)
Complications
• Chronic kidney disease
• Infections (due to immunosuppression)
• Cardiovascular disease
• Osteoporosis
• Pregnancy complications
Prognosis
The prognosis of SLE has improved significantly due to:
• Early diagnosis
• Better immunosuppressive therapy
• Improved supportive care
Five-year survival now exceeds 90%, though long-term morbidity
remains a concern.
Conclusion
Systemic Lupus Erythematosus is a complex autoimmune disease
with diverse clinical manifestations and unpredictable course. Early
recognition, appropriate investigation, and individualized treatment
are essential to prevent organ damage and improve quality of life. A
multidisciplinary approach involving rheumatologists, nephrologists,
and other specialists plays a crucial role in optimal disease
management.