Multisystem autoimmune disease with autoantibodies (ANA, dsDNA); relapsing-remitting course.
History taking
- • Fatigue, fever, weight loss
- • Photosensitive rash, oral ulcers, alopecia
- • Joint pain, Raynaud, pleuritic chest pain
Examination
- • Malar rash, discoid lesions
- • Non-erosive arthritis
- • Serositis, lymphadenopathy
Red flags
- • Neurolupus, severe nephritis, haemolytic crisis
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • ANA (screen), anti-dsDNA, anti-Sm
- • C3/C4, urinalysis + ACR
- • CBC, RFT, LFT, APS antibodies
Diagnosis
- • EULAR/ACR 2019 criteria (ANA ≥1:80 + ≥10 points)
Initial treatment / management
- • Sun protection + hydroxychloroquine for all
- • Add steroids/immunosuppression by organ involvement
Drug therapy
- • Hydroxychloroquine 5 mg/kg/day
- • Prednisolone for flares
- • Mycophenolate / azathioprine / belimumab as steroid-sparing
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Strict sun protection (SPF 50+)
- • Contraception (avoid oestrogen if APS+)
- • Pregnancy planning in remission
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
Clinical pearls
- • Annual ophthalmic screen for HCQ retinal toxicity after 5 years
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
