Systemic lupus erythematosus

Epidemiology

• much more common in females (F:M = 9:1)
• more common in Afro-Caribbeans^ and Asian communities
• onset is usually 20-40 years
• incidence has risen substantially during the past 50 years (3 fold using American College of Rheumatology criteria)

Pathophysiology

• autoimmune disease: SLE a type 3 hypersensitivity reaction
• associated with HLA B8, DR2, DR3
• thought to be caused by immune system dysregulation leading to immune complex formation
• immune complex deposition can affect any organ including the skin, joints, kidneys and brain

The malar rash, arthralgia, lethargy and history of mental health points towards a diagnosis of SLE. Remember that the CRP (in contrast to the ESR) is typically normal in SLE.

Alopecia is common but not in diagnostic criteria.

The 11 diagnostic criteria set by the American College of Rheumatology can be easily remembered by remembering

SOAP BRAIN MD

Serositis such pleuritis or pericarditis

Oral ulcers

Arthritis (usually oligo or polyarticular)