Diagnosis / Suspected SLE is based on

• Disease history (check SLICC criteria below)
• Medical investigation and findings
• Laboratory tests
• Tissues from kidneys (kidney biopsy) if kidney involvement
• SLE begins most commonly in women of childbearing age, more often among people from Asia and Africa
• Differential diagnoses, please see here

Disease history (anamnesis) at SLE (Syndrome)¹included in SLICC criteria, ²ACR criteria)

• Time of
  • Disease debut
    • Diagnosis and debut symptoms
• ¹Acute or chronic skin changes (eczema)
• ^1,2Frequent mouth ulcer
• ¹Alopecia (stinging hair loss)
• ^1,2Arthritis (small joint is most common)
• ^1,2Serotonitis (pleuritis, pericarditis)
• ^1,2Kidney disorders (proteins and blood in the urine by glomerulonephritis)
• ^1,2Neurological (cramps, psychosis)
• ^1,2blood Cells
  • Hemolytic anemia (high LD and reticulocytes, low haptoglobin)
  • Leukopenia
  • Thrombocytopenia
• ^1,2Antibodies
  • ANA
  • DNA
  • Sm
  • Antifosfolipid antibodies (Lupus Anticoagulant, Cardiolipin, Beta-2-Glycoprotein)
• * Low complement factors
  • C3 and / or C 4
• ²Butterfly Rash (on the cheeks) **
• ²Diskoid rash**
• ²Sun rash (Photosensitivity **

Other manifestations

• Affected general condition: Night sweat / subfebril / fever?
• Antifosfolipid syndrome (Secondary)
  • Thromboses: venous and arterial?
  • Miscarriages?
• Joint
  • Yesccoud joints (with errors) (2%)
  • Erosive Arthritis (Usurer) (5%)
• Heart
  • Endocarditis (Libman-Sacks)
  • Pulmonary hypertension (rarely at SLE)
• Nervous System
  • Central nervous (CNS) affection:
    • Headache/Cognitive disorders/ Apoplexy / Epilepsy /
    • Findings in MRI and MRI Angiography, SPECT, PET / CT
    • Polynesia / Peripheral pares
• Dry mucous membranes
  • Sicca phenomena (Secondary Sjögren's syndrome)
• Raynaud's phenomenon?
• Autoantibodies
  • RNP (MCTD?)
  • SSA / B (subacute cutaneous lupus, primarily Sjøgrens syndrome?)

• High Sedimentation rate (ESR), low CRP
• Weight loss last 3-6 months
• Immunosuppressive treatment until now
  • Prednisone
  • Plaquenil
  • Azathioprine
  • Methotrexate
  • Mycophenolate (CellCept)
  • Cyclophosphamide
• Planned pregnancy?

Clinical examination at SLE

• Blood pressure and pulse
• Heart and lungs (auscultation)
• Skin and hair
• Joint
• Edema (kidney)
• Neurological

Blood and urine samples

• The sedimentation rate (ESR) is often high
• CRP almost normal, but increases with infection, arthritis and pulmonary (pleurisy) or heart bag inflammation (pericarditis)
• Cell counts (Hemoglobin, lymphocytic leukocytes, platelets)
• Complement factors C3 and C4
• Urine with signs of glomerulonephritis (proteins, blood, protein / creatinine, cylinders)
• Blood tests that take initially, then rarely
  • Antibody samples (in blood) ANA, ENA, DNA antibody, anti C1q
  • Antifosfolipid antibodies (Lupus anticoagulant via hematological / coagulation laboratory), α-cardiolipin and beta-2 glycoprotein (β-2GP).

X-ray examination of lungs

• Exclude signs of manifestations in the pleura / pericard
• «Shrinking lung» with diaphragm height

What we should also ask the patient about

• How strong is your pain today (scale 0-100)?
• How strong is the fatigue today (scale 0-100)?
• How do you perceive your disease activity today (scale 0–100)?
• (The doctor can also add his assessment of the disease activity, scale 0-100)

Follow-up

• All patients with aktiv SLE should be followed up by both a specialist and a GP
• The frequency of controls will depend on the disease activity, complications and medications used
• If new symptoms, check keywords for medical history (see above)
• Clinical examinations as mentioned above
• Blood and urine are checked
  • Antibody and complement factors need not be checked every time
• By pregnancy close monitoring of rheumatologists and obstetricians should be organized as soon as possible
• Validated targets for disease activity can be done at SLEDAI

Referral to specialist

• Define what the diagnosis / suspicion of SLE is based on (see above)

Patients should preferably be referred to local rheumatological department. Patients living in the Health Region South-East can also be referred Rheumatology Department, Rikshospitalet, Oslo
Postbox 4950 Nydalen, 0424 OSLO. The department can receive patients also from the country by the way when the capacity allows.

Norwegian Directorate of Health (Supervisor for referrals)

• SLE, BINDEVEVSSYDKOMMER.no
• Bindevevssykdommer.no
• Vaskulitt.no