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26th February 2025
Clinical features of SLE
SLE can affect multiple organs and also often causes constitutional symptoms such as fever, fatigue and weight loss.
The revised American College of Rheumatology classification criteria, commonly used for diagnosis, can be remembered using the mnemonic SOAP BRAIN MD as follows:
| Serositis | Pleuritis (pleural rub on examination, pleuritic pain or effusion on imaging) or pericarditis (pericardial rub on examination, ECG changes, evidence of pericardial effusion) |
| Oral ulcers | Oral or nasopharyngeal. Generally painless, most commonly involving the hard palate |
| Arthralgia & arthritis | Symmetrical arthralgia or arthritis is common; however, joint damage is rare. Joint subluxation due to non-erosive arthropathy can occur – Jaccoud’s arthropathy |
| Photosensitivity | Skin rash on exposure to sunlight |
| Blood abnormalities | Leukopenia, lymphopaenia or thrombocytopaenia on more than one occasion |
| Renal | Persistent proteinuria >0.5 g/day or 3+ on dip. Casts in urine |
| ANA positivity | ANA positivity at any titre, however at low titres (<1:320) there will be many false positives |
| Immunological | Antibodies as described below |
| Neurological | Seizures or psychosis in absence of other cause |
| Malar rash | ‘Butterfly’ rash to face, sparing the nasolabial folds |
| Discoid rash | Erythematous, scaly, disc-like plaques |
Table 1 Diagnostic features in SLE
Other respiratory manifestations can occur, including pulmonary fibrosis or hypertension, and shrinking lung syndrome. This is characterised by increased dyspnoea, diaphragmatic elevation and decreased lung volumes on CXR, and restrictive pulmonary function tests with no parenchymal lung disease. This can be treated with steroids.
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