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)

Photosensitivity

Blood disorders: namely hemolytic anemia, leukopenia, lymphopenia, and thrombocytopenia

Renal involvement with nephrotic picture

Anti nuclear antibodies in 95% of patients

Immunologic abnormalities such as Anti-Sm, Anti-dsDNA, Anti-phospholipid, low complement, postive syphilis serology

Neurologic: mainly seizure and psychosis

Malar rash (spares nasolabial folds and areas beneath the nose and lower lip; otherwise, think of Rosacea)

Discoid rash

4 out of these 11 will label the patient having SLE

Immunology

• 99% are ANA positive
• 20% are rheumatoid factor positive