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 (in Danish)

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

0 Nydalen, 0424 OSLO. The ward can also receive patients from the rest of the country when the capacity allows it.

Norwegian Directorate of Health (Supervisor for referrals)

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