Clinical Findings in Systemic Lupus Erythematosus (SLE)
Systemic Lupus Erythematosus presents with diverse clinical manifestations affecting multiple organ systems, with mucocutaneous, musculoskeletal, renal, and neuropsychiatric manifestations being the most common findings that significantly impact morbidity and mortality. 1, 2
Mucocutaneous Manifestations
LE-specific lesions:
Other skin findings:
Diagnostic considerations:
- Skin biopsy may be necessary for definitive diagnosis
- Follow-up biopsy recommended if lesions change morphology or fail to respond to treatment 1
Musculoskeletal Manifestations
- Arthralgia (joint pain) - present in 68.8% of patients 3
- Myalgia (muscle pain) - present in 55.7% of patients 3
- Non-erosive arthritis - present in 48.3% of patients 3
- Myositis - present in 2.5% of patients 3
- Avascular necrosis - present in 2% of patients 3
- Tendon abnormalities - present in 0.3% of patients 3
Renal Manifestations
- Lupus nephritis occurs in approximately 40% of patients 4
- Clinical findings include:
- Proteinuria
- Hematuria
- Cellular casts
- Elevated serum creatinine
- Hypertension
- Renal disease is associated with:
Neuropsychiatric Manifestations
- Common neuropsychiatric syndromes include:
- Headache
- Mood disorders
- Seizures
- Cognitive impairment (memory, attention, concentration, word-finding difficulties)
- Cerebrovascular disease 1
- Assessment requires:
- Clinical history
- Neuroimaging
- Cerebrospinal fluid analysis
- Electroencephalogram
- Neuropsychological testing
- Nerve conduction studies 2
Constitutional Symptoms
- Fatigue - present in 35.2% of patients 3
- Fever
- Weight changes - present in 13.4% of patients 3
- Constitutional symptoms overall present in 48.7% of patients 3
Hematologic Abnormalities
- Anemia (severe anemia associated with organ involvement and worse prognosis)
- Thrombocytopenia (associated with renal disease and disease progression)
- Leukopenia/lymphopenia (associated with increased infection risk) 1
Serological Findings
- Anti-dsDNA antibodies (correlate with disease activity, especially renal disease)
- Low complement levels (C3, C4)
- Antiphospholipid antibodies (associated with thrombotic manifestations)
- C-reactive protein (CRP) is typically not elevated in SLE flares; significant elevation (>50 mg/L) suggests superimposed infection 1
Cardiovascular Findings
- Accelerated atherosclerosis
- Pericarditis
- Myocarditis
- Libman-Sacks endocarditis
- Patients have almost 5-fold increased risk of death compared to general population 1, 2
Ocular Manifestations
- Retinal vasculitis
- Optic neuritis
- Antimalarial-induced retinopathy (rare complication of treatment, 0.5% incidence) 1
Pulmonary Manifestations
- Pleuritis
- Pneumonitis
- Pulmonary hypertension
- Interstitial lung disease
- Shrinking lung syndrome
Common Comorbidities
- Infections (major cause of morbidity and mortality)
- Hypertension
- Coronary heart disease
- Diabetes mellitus
- Dyslipidemia
- Osteoporosis
- Avascular bone necrosis
- Increased risk for certain cancers (non-Hodgkin's lymphoma, lung cancer, hepatobiliary cancer) 1, 2
Clinical Pearls and Pitfalls
- SLE predominantly affects females (90% of cases) 4
- Disease presentation varies widely in severity from mild rashes and arthritis to severe organ and life-threatening manifestations 5
- Elevated CRP with normal ESR suggests infection rather than SLE flare 1
- Regular monitoring of disease activity using validated indices (SLEDAI, BILAG) is essential 2
- Early diagnosis and treatment significantly improve outcomes and reduce organ damage