How lupus presents
Systemic lupus erythematosus (SLE) is a multisystem autoimmune condition in which autoantibodies attack healthy tissue, causing inflammation and damage. It most commonly affects women of childbearing age. Clinical presentations vary widely — from mild skin and joint involvement (the malar rash, arthritis) to life-threatening nephritis, cytopenias, serositis (pleurisy, pericarditis) or neuropsychiatric disease.
Accurate diagnosis requires correlation of clinical features with autoantibody testing. The malar rash (butterfly rash across cheeks and nose), photosensitivity, oral ulcers, arthritis, Raynaud’s phenomenon, and unexplained fatigue or fever are common early features. Multi-organ involvement demands systematic assessment before treatment decisions.
- Malar rash — butterfly rash across cheeks and nose
- Photosensitivity — skin rash worsened by sunlight
- Oral or nasal ulcers — often painless
- Arthritis — typically non-erosive, symmetric
- Raynaud’s phenomenon — finger colour change with cold
Related: Rheumatology → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Treatment and monitoring
Hydroxychloroquine is a cornerstone of lupus treatment for all patients, reducing flare frequency, organ damage and thrombotic risk. Corticosteroids are used for flares, with the goal of minimising long-term steroid exposure. Immunosuppressive agents (mycophenolate, azathioprine, cyclophosphamide) are used for organ-threatening disease. Biologic agents (belimumab, anifrolumab) target specific immune pathways.
Regular monitoring includes disease activity assessment (SLEDAI score), inflammatory markers, complement levels, anti-dsDNA titres, renal function, urinalysis and blood counts. Medication safety monitoring (hydroxychloroquine eye screening, immunosuppressant blood counts) is essential. Pregnancy planning requires early discussion as some medications are teratogenic.
- Hydroxychloroquine — cornerstone for all lupus patients
- Corticosteroids — flares, with steroid-sparing strategy
- Immunosuppressants — mycophenolate, azathioprine, cyclophosphamide
- Biologics — belimumab, anifrolumab for refractory disease
- Regular monitoring — SLEDAI, complement, anti-dsDNA, renal function