26th January 2024

Presentation

Articular Manifestations 

Joint involvement is common and present in approximately 95% of patients diagnosed with SLE. In 75% of patients,  it is the presenting complaint. The arthritis of SLE is typically non-erosive, symmetrical and polyarticular. Joints commonly affected include the proximal interphalangeal joints (PIPs), carpal joints and knees. On examination, joint deformities may resemble those seen in RA, such as ulnar deviation and thumb subluxation and are referred to as Jaccoud’s arthropathy. However, Jaccoud’s arthropathy results from soft tissue abnormalities and is a non-erosive, reversible joint disorder, unlike Rheumatoid Arthritis. 

Image Source: Abushama S et al. (2021) A Sudanese male with Jaccoud’s arthropathy; case report. Biomed J Sci & Tech Res 33(2)-2021. Licensed under a commercial Creative Commons license. Available at: https://biomedres.us/pdfs/BJSTR.MS.ID.005387.pdf (Accessed: 21 December 2023).

Cutaneous Manifestations

Skin involvement is often the first sign in SLE, and about 80% of patients with SLE will have skin signs. Common skin signs include malar or “butterfly” rash, photosensitivity rashes, hair loss, discoid lupus – indurated, hyper-pigmented plaques, and muco-cutaneous involvement. On examination, active lesions of discoid lupus may present as erythematous, circular, scaly plaques, while healed lesions show a characteristic depigmented central area with surrounding hyper-pigmentation and an atrophic centre. The alopecia seen is scarring alopecia that often results in permanent hair loss. 

Image Source: Wikimedia Commons (2022).Lupusfoto, Licensed under a creative commons licence. Available for free at: https://upload.wikimedia.org/wikipedia/commons/5/52/Lupusfoto.jpg (Accessed: 10 July 2022).

Image Source: Wikimedia Commons (2022). Discoid lupus erythematosus, Licensed under a creative commons licence. Available for free at: https://upload.wikimedia.org/wikipedia/commons/b/ba/Discoid_lupus_erythematosus.JPG (Accessed: 10 July 2022).

Image Source: Wikimedia Commons (2022). Discoid lupus etythermayouses new image, Licensed under a creative commons licence. Available for free at: https://upload.wikimedia.org/wikipedia/commons/9/91/Discoid_lupus_etythermayouses_new_image.jpg (Accessed: 10 July  2022).

Non-articular Systemic Manifestations of SLE 

• General: fatigue (the most common complaint), intermittent fever, weight loss
• Cardiac: pericarditis with or without pericardial effusion (most common cardiac manifestation) 
• Pulmonary: pleuritis, pneumonitis, interstitial lung disease, pulmonary hypertension
• Vascular: Raynaud’s phenomenon (occurs in up to 50% of patients with SLE), vasculitis – most commonly small vessel and can manifest as petechiae, palpable purpura, livedo reticularis, panniculitis and superficial ulcerations 
• Renal: Renal involvement occurs in approximately 50% of SLE patients. Different forms of glomerulonephritis can occur and may present with proteinuria/nephrotic syndrome or asymptomatic haematuria.
• Neurologic and Neuropsychiatric: Symptoms and presentations can include cognitive dysfunction, delirium, psychosis, strokes, seizures, and peripheral neuropathies.
• Haematological: Anaemia of chronic disease is the most common presentation. Leukopenia is also common and occurs in approximately 50% of patients and generally correlates to disease activity. 
• Ophthalmologic: Keratoconjunctivitis is the most common manifestation and is as a result of secondary Sjogren’s syndrome