Education And Debate


BMJ 1995; 310 doi: (Published 13 May 1995) Cite this as: BMJ 1995;310:1257
  1. Elaine M Hay,
  2. Michael L Snaith

    Systemic lupus erythematosus is one of a family of interrelated and overlapping autoimmune rheumatic disorders that includes rheumatoid arthritis, scleroderma, polymyositis, dermatomyositis, and Sjogren's syndrome. The disease can present as a wide variety of clinical features, reflecting the many organ systems that can be affected. This clinical diversity is matched serologically by a wide spectrum of autoantibodies, which tend to cluster in relation to the clinical pattern.

    Systemic lupus erythematosus is rare: a general practice with 10000 registered patients is unlikely to have more than three or four patients with the disease at any one time. It is nine times more common in women than in men, and nine times more common in Afro-Caribbeans and Asians than in white patients. Thus, general practitioners' experience will vary greatly according the ethnic mix of their registered population.

    Classification criteria for systemic lupus erythematosus (revised 19821)

    To be classified as having systemic lupus erythematosus, patients must have at least four of the following criteria in the course of their disease:

    • Malar rash

    • Photosensitivity

    • Arthritis

    • Renal disorder

    • Haematological

    • Presence of antinuclear antibodies

    • Discoid rash

    • Oral ulcers

    • Serositis

    • Neurological disorder

    • Immunological disorder disorder

    Clinical presentation

    Consider systemic lupus erythematosus in a young woman presenting with “seronegative rheumatoid arthritis”

    Jaccoud-type arthropathy; non-erosive deformity of fingers owing to tendons being affected.

    Because lupus is so uncommon, one difficulty is considering the possibility in the first place, particularly if the presentation is atypical or the patient is elderly or male. Differentiating lupus from similar disorders can be difficult, particularly early in the course of the disease, because many of the clinical features are common non-specific complaints. Although classification criteria for lupus are widely accepted, they are more appropriate for classifying patients in clinical trials or epidemiological studies than for making a diagnosis in individual patients. Lupus should be considered when characteristic clinical features—most commonly arthralgia, mucocutaneous manifestations, and …

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