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| ===Appearance of the Patient=== | | ===Appearance of the Patient=== |
| *Patient appears well in the earlier stages of the disease | | * Patient with [[septic arthritis]] usually appears [[toxic]] and with [[joint pain]] |
| *Patient appears ill in the late stages of the disease due to multi-organ involvement
| | * children usually appear [[irritable]] |
| ===Vital Signs===
| |
| *[[Fever]] higher than 38 after the exclusion of [[infection]]
| |
| *[[Tachycardia]]/[[bradycardia]] depends on the accompanying complication
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| *[[Tachypnea]]/[[bradypnea]] depends on the accompanying complication | |
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| === Skin<ref name="pmid25077888">{{cite journal |vauthors=Parodi A, Cozzani E |title=Cutaneous manifestations of lupus erythematosus |journal=G Ital Dermatol Venereol |volume=149 |issue=5 |pages=549–54 |year=2014 |pmid=25077888 |doi= |url=}}</ref><ref name="pmid26985173">{{cite journal |vauthors=Szczęch J, Rutka M, Samotij D, Zalewska A, Reich A |title=Clinical characteristics of cutaneous lupus erythematosus |journal=Postepy Dermatol Alergol |volume=33 |issue=1 |pages=13–7 |year=2016 |pmid=26985173 |pmc=4793050 |doi=10.5114/pdia.2014.44031 |url=}}</ref><ref name="pmid19824738">{{cite journal |vauthors=Walling HW, Sontheimer RD |title=Cutaneous lupus erythematosus: issues in diagnosis and treatment |journal=Am J Clin Dermatol |volume=10 |issue=6 |pages=365–81 |year=2009 |pmid=19824738 |doi=10.2165/11310780-000000000-00000 |url=}}</ref> === | | === Vital Signs === |
| *[[Cyanosis]] | | * Low grade [[fever]]. [[Chills]] and spiking fever are very rare. |
| **Secondary to [[respiratory]] complications
| | * [[Hyperthermia]] over the joint involved |
| *[[Jaundice]]
| | * [[Tachycardia]] |
| **Secondary to [[hepatitis]]
| | * [[Tachypnea]] |
| *[[Pallor]]
| |
| **Secondary to [[anemia]]
| |
| *Generalised [[erythema]]
| |
| *[[Bruises]]
| |
| **Secondary to [[thrombocytopenia]]
| |
| *[[Urticaria]]
| |
| *[[Bullous|Bullous lesions]]
| |
| *[[Sclerodactyly]]
| |
| *Skin [[Ulcerations|ulceration]]
| |
| *[[Malar rash]]: the classic lupus ‘butterfly’ rash
| |
| ** [[Erythema|Erythematous]], elevated [[Lesions|lesion]], [[Pruritis|pruritic]] or painful, in a [[malar]] distribution, commonly precipitated by exposure to sunlight
| |
| * Annular or psoriasiform skin [[lesions]]
| |
| ** Small, [[erythematous]], slightly scaly [[papules]] that evolve into either a psoriasiform (papulosquamous) or annular form and tend to involve shoulders, forearms, neck, and upper torso
| |
| * [[Scarring]] [[chronic]] [[alopecia]]
| |
| ** Mostly present on face, neck, and scalp
| |
| * [[Telangiectasias]]
| |
| * Dyspigmentation ([[hyperpigmentation]] or [[hypopigmentation]]) of skin in [[scar]] places
| |
| * Follicular plugging
| |
| ** Discrete, [[erythematous]], slightly infiltrated [[plaques]] covered by a well-formed adherent scale that extends into dilated [[hair follicles]]
| |
| * [[Nodules]]
| |
| ** Can be firm (Lupus profundus) and painful
| |
| * Photodistributed [[lesions]] with chronic pink indurated plaques or broad [[lesions]] that are slow to heal (more seen in lupus tumidus)
| |
| * Thin hair that easily fractures (lupus hair)
| |
| * Irregularly shaped raised white plaques, areas of erythema, silvery white scarred [[lesions]], and [[ulcers]] with surrounding [[erythema]] on the soft or hard palate or buccal [[mucosa]] | |
| * Periungual [[erythema]] | |
| ** Dilated tortuous loops of [[capillaries]] and a prominent subcapillary venous plexus along | |
| ** Involves the base of the nail and edges of the upper [[eyelid]]
| |
| [[File:Systemic lupus erythematosus 055.jpg|300px]]
| |
| '''For more pictures of the rash presentation in lupus, click [[Systemic lupus eryhthematosus physical examination:Gallery|here]].'''
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| ===HEENT=== | | === Skin === |
| *[[Ophthalmology]]<ref name="pmid26367085">{{cite journal |vauthors=Preble JM, Silpa-archa S, Foster CS |title=Ocular involvement in systemic lupus erythematosus |journal=Curr Opin Ophthalmol |volume=26 |issue=6 |pages=540–5 |year=2015 |pmid=26367085 |doi=10.1097/ICU.0000000000000209 |url=}}</ref><ref name="pmid25904124">{{cite journal |vauthors=Silpa-archa S, Lee JJ, Foster CS |title=Ocular manifestations in systemic lupus erythematosus |journal=Br J Ophthalmol |volume=100 |issue=1 |pages=135–41 |year=2016 |pmid=25904124 |doi=10.1136/bjophthalmol-2015-306629 |url=}}</ref> | | * Warmth over the joint |
| **[[Nystagmus]]
| |
| **Visual [[Retinal|retinal changes]] from systemic lupus erythematosus cytoid bodies, [[Retina|retinal]] [[haemorrhages]], serous exudate or [[haemorrhage]] in the [[choroid]], [[optic neuritis]] (not due to [[hypertension]], drugs or [[infection]])
| |
| **[[Cataract]]
| |
| **[[Optic nerve atrophy]]
| |
| **[[Icterus|Icteric sclera]]
| |
| **[[Cotton wool spots]] in the [[retina]] in [[Ophthalmoscopy|ophthalmoscopic exam]]
| |
| *Nasal [[ulcers]]<ref name="pmid1526055">{{cite journal |vauthors=Robson AK, Burge SM, Millard PR |title=Nasal mucosal involvement in lupus erythematosus |journal=Clin Otolaryngol Allied Sci |volume=17 |issue=4 |pages=341–3 |year=1992 |pmid=1526055 |doi= |url=}}</ref>
| |
| **Mostly painless
| |
| **Mostly in lower [[nasal septum]] and [[bilateral]] and parallel
| |
| **Nasal perforation secondary to [[vasculitis]] may happen rarely
| |
| *Oral [[ulcers]]<ref name="pmid23780804">{{cite journal |vauthors=Anyanwu CO, Ang CC, Werth VP |title=Oral mucosal involvement in bullous lupus |journal=Arthritis Rheum. |volume=65 |issue=10 |pages=2622 |year=2013 |pmid=23780804 |pmc=4333153 |doi=10.1002/art.38051 |url=}}</ref><ref name="pmid23248469">{{cite journal |vauthors=Ranginwala AM, Chalishazar MM, Panja P, Buddhdev KP, Kale HM |title=Oral discoid lupus erythematosus: A study of twenty-one cases |journal=J Oral Maxillofac Pathol |volume=16 |issue=3 |pages=368–73 |year=2012 |pmid=23248469 |pmc=3519212 |doi=10.4103/0973-029X.102487 |url=}}</ref>
| |
| **Mostly painless
| |
| **White plaques with areas of [[erythema]], or punched-out erosions or ulcers with surrounding [[erythema]] on the soft or hard palate or [[buccal mucosa]]
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|
| ===Neck<ref name="pmid19107085">{{cite journal |vauthors=Melikoglu MA, Melikoglu M |title=The clinical importance of lymphadenopathy in systemic lupus erythematosus |journal=Acta Reumatol Port |volume=33 |issue=4 |pages=402–6 |year=2008 |pmid=19107085 |doi= |url=}}</ref><ref name="pmid24722263">{{cite journal |vauthors=Sacre K, Escoubet B, Pasquet B, Chauveheid MP, Zennaro MC, Tubach F, Papo T |title=Increased arterial stiffness in systemic lupus erythematosus (SLE) patients at low risk for cardiovascular disease: a cross-sectional controlled study |journal=PLoS ONE |volume=9 |issue=4 |pages=e94511 |year=2014 |pmid=24722263 |pmc=3983200 |doi=10.1371/journal.pone.0094511 |url=}}</ref>===
| | * [[Erythema]] over the around the joint that involved |
| *[[Jugular venous distension]] | | * [[Disseminated gonococcal infection]] often present with [[skin]] lesions, typically multiple, painless [[macules]] and [[papules]], most often found on the arms or legs or on the [[trunk]].<ref name="pmid9449882">Goldenberg DL (1998) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9449882 Septic arthritis.] ''Lancet'' 351 (9097):197-202. [http://dx.doi.org/10.1016/S0140-6736(97)09522-6 DOI:10.1016/S0140-6736(97)09522-6] PMID: [https://pubmed.gov/9449882 9449882]</ref> |
| **Secondary to [[hypertension]] and cardiac complications | |
| *[[Lymphadenopathy]]
| |
| ** [[Lymph node|Lymph nodes]] are soft, non-tender, discrete
| |
| ** Usually detected in the [[cervical]], [[axillary]], and [[inguinal]]
| |
|
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|
| ===Lungs<ref name="pmid21194884">{{cite journal |vauthors=Torre O, Harari S |title=Pleural and pulmonary involvement in systemic lupus erythematosus |journal=Presse Med |volume=40 |issue=1 Pt 2 |pages=e19–29 |year=2011 |pmid=21194884 |doi=10.1016/j.lpm.2010.11.004 |url=}}</ref><ref name="pmid26550810">{{cite journal |vauthors=Salvati F |title=[The involvement of pulmonary interstitial tissue in multisystemic lupus erythematosus: interdisciplinarity and role of the pneumologists] |language=Italian |journal=Clin Ter |volume=166 |issue=5 |pages=205–7 |year=2015 |pmid=26550810 |doi= |url=}}</ref><ref name="pmid25639532">{{cite journal |vauthors=Alamoudi OS, Attar SM |title=Pulmonary manifestations in systemic lupus erythematosus: association with disease activity |journal=Respirology |volume=20 |issue=3 |pages=474–80 |year=2015 |pmid=25639532 |pmc=4418345 |doi=10.1111/resp.12473 |url=}}</ref>=== | | === Extremities === |
| *Fine and coarse [[crackles]] upon auscultation of the [[lung]]
| | Most commonly involves [[knee]] > [[hip]] > [[shoulder]] > [[ankle]].<ref name="pmid3498362">Barton LL, Dunkle LM, Habib FH (1987) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3498362 Septic arthritis in childhood. A 13-year review.] ''Am J Dis Child'' 141 (8):898-900. PMID: [https://pubmed.gov/3498362 3498362]</ref> Other joints such as [[sacroiliac joint]] (~10%), [[sternoclavicular]] or costoclavicular joints may be involved in patient with history of intravenous drug abuse (IVDA), penetrating trauma, animal or human bites and local [[steroid]] [[injections]]. |
| **May be due to [[pneumonitis]]
| | * [[Swelling]] of the joint that involved |
| *In case of [[pleural effusion]]:
| | * Decreased [[range of motion]] such as pseudo paralysis |
| **Asymmetric [[tactile fremitus]]
| | * Patient hold the hip in flexed and externally rotated position if SA involving [[hip]]. |
| **Asymmetric [[chest expansion]]
| | * If child, unwillingness to bear weight on the affected joint (antalgic gait) |
| | |
| ===Heart<ref name="pmid24790989">{{cite journal |vauthors=Mak A, Kow NY |title=Imbalance between endothelial damage and repair: a gateway to cardiovascular disease in systemic lupus erythematosus |journal=Biomed Res Int |volume=2014 |issue= |pages=178721 |year=2014 |pmid=24790989 |pmc=3984775 |doi=10.1155/2014/178721 |url=}}</ref><ref name="pmid24722263">{{cite journal |vauthors=Sacre K, Escoubet B, Pasquet B, Chauveheid MP, Zennaro MC, Tubach F, Papo T |title=Increased arterial stiffness in systemic lupus erythematosus (SLE) patients at low risk for cardiovascular disease: a cross-sectional controlled study |journal=PLoS ONE |volume=9 |issue=4 |pages=e94511 |year=2014 |pmid=24722263 |pmc=3983200 |doi=10.1371/journal.pone.0094511 |url=}}</ref><ref name="pmid23052654">{{cite journal |vauthors=Canpolat N, Kasapcopur O, Caliskan S, Gokalp S, Bor M, Tasdemir M, Sever L, Arisoy N |title=Ambulatory blood pressure and subclinical cardiovascular disease in patients with juvenile-onset systemic lupus erythematosus |journal=Pediatr. Nephrol. |volume=28 |issue=2 |pages=305–13 |year=2013 |pmid=23052654 |doi=10.1007/s00467-012-2317-3 |url=}}</ref>===
| |
| *Chest [[tenderness]] or discomfort upon palpation
| |
| **May be due to [[costochondritis]]
| |
| *[[Diastolic murmurs|Diastolic murmur]], or [[Systolic murmurs|systolic murmur]] >3/6 due to [[valvular disease]]
| |
| *Loud second heart sound (due to [[pulmonary hypertension]])
| |
| *Loud S1-S2 due to [[cardiomegaly]]
| |
| *Decrease heart sounds if associated with [[pericardial effusion]]
| |
| | |
| ===Abdomen<ref name="pmid20572299">{{cite journal |vauthors=Tian XP, Zhang X |title=Gastrointestinal involvement in systemic lupus erythematosus: insight into pathogenesis, diagnosis and treatment |journal=World J. Gastroenterol. |volume=16 |issue=24 |pages=2971–7 |year=2010 |pmid=20572299 |pmc=2890936 |doi= |url=}}</ref><ref name="pmid27329649">{{cite journal |vauthors=Alves SC, Fasano S, Isenberg DA |title=Autoimmune gastrointestinal complications in patients with systemic lupus erythematosus: case series and literature review |journal=Lupus |volume=25 |issue=14 |pages=1509–1519 |year=2016 |pmid=27329649 |doi=10.1177/0961203316655210 |url=}}</ref><ref name="pmid27055518">{{cite journal |vauthors=Fawzy M, Edrees A, Okasha H, El Ashmaui A, Ragab G |title=Gastrointestinal manifestations in systemic lupus erythematosus |journal=Lupus |volume=25 |issue=13 |pages=1456–1462 |year=2016 |pmid=27055518 |doi=10.1177/0961203316642308 |url=}}</ref><ref name="pmid28523968">{{cite journal |vauthors=Li Z, Xu D, Wang Z, Wang Y, Zhang S, Li M, Zeng X |title=Gastrointestinal system involvement in systemic lupus erythematosus |journal=Lupus |volume= |issue= |pages=961203317707825 |year=2017 |pmid=28523968 |doi=10.1177/0961203317707825 |url=}}</ref>===
| |
| *[[Abdominal distention]]
| |
| *[[Ascites]]
| |
| **Due to [[nephrotic syndrome]]
| |
| *[[Abdominal pain]]
| |
| **Due to [[Vasculitis|mesentric vasculitis]]
| |
| *[[Hepatomegaly]]
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| *[[Splenomegaly]]
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| *Costo-vertebral angle tenderness
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| | |
| ===Extremities<ref name="pmid15580980">{{cite journal |vauthors=Zoma A |title=Musculoskeletal involvement in systemic lupus erythematosus |journal=Lupus |volume=13 |issue=11 |pages=851–3 |year=2004 |pmid=15580980 |doi=10.1191/0961203303lu2021oa |url=}}</ref><ref name="pmid22956550">{{cite journal |vauthors=Gabba A, Piga M, Vacca A, Porru G, Garau P, Cauli A, Mathieu A |title=Joint and tendon involvement in systemic lupus erythematosus: an ultrasound study of hands and wrists in 108 patients |journal=Rheumatology (Oxford) |volume=51 |issue=12 |pages=2278–85 |year=2012 |pmid=22956550 |doi=10.1093/rheumatology/kes226 |url=}}</ref><ref name="pmid19591780">{{cite journal |vauthors=Grossman JM |title=Lupus arthritis |journal=Best Pract Res Clin Rheumatol |volume=23 |issue=4 |pages=495–506 |year=2009 |pmid=19591780 |doi=10.1016/j.berh.2009.04.003 |url=}}</ref><ref name="pmid24862229">{{cite journal |vauthors=Zhu KK, Xu WD, Pan HF, Zhang M, Ni J, Ge FY, Ye DQ |title=The risk factors of avascular necrosis in patients with systemic lupus erythematosus: a meta-analysis |journal=Inflammation |volume=37 |issue=5 |pages=1852–64 |year=2014 |pmid=24862229 |doi=10.1007/s10753-014-9917-y |url=}}</ref><ref name="pmid23731640">{{cite journal |vauthors=Voulgari PV, Kosta P, Argyropoulou MI, Drosos AA |title=Avascular necrosis in a patient with systemic lupus erythematosus |journal=Joint Bone Spine |volume=80 |issue=6 |pages=665 |year=2013 |pmid=23731640 |doi=10.1016/j.jbspin.2013.03.018 |url=}}</ref>===
| |
| *[[Clubbing]]
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| *[[Cyanosis]]
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| *[[Muscle weakness|Muscle atrophy or weakness]]
| |
| *[[Livedo reticularis]] | |
| **Reddish-cyanotic, reticular pattern on the skin of the arms, legs, and torso, particularly with cold exposure
| |
| *[[Arthritis]] | |
| **Symmetrical
| |
| **Polyarticular
| |
| **Mostly involve knees, carpal joints, and joints of the fingers, especially the proximal [[interphalangeal]] (PIP) joint
| |
| **Decrease range of motion in affected joints
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| *Joints [[erythema]]
| |
| **Due to [[synovitis]] | |
| *Joint effusion
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| *Muscle [[atrophy]]
| |
| *[[Fasciculations]] in the upper/lower extremity
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| *[[Claudication]]
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| *Loss of digit or limb | |
| | |
| ===Neuromuscular<ref name="pmid19366083">{{cite journal |vauthors=Cojocaru IM, Cojocaru M, Tănăsescu R, Burcin C, Atanasiu AN, Silosi I |title=Detection of autoantibodies to ribosome P in lupus patients with neurological involvement |journal=Rom J Intern Med |volume=46 |issue=3 |pages=239–42 |year=2008 |pmid=19366083 |doi= |url=}}</ref><ref name="pmid22594009">{{cite journal |vauthors=Madrane S, Ribi C |title=[Central neuropsychiatric involvement in systemic lupus erythematosus] |language=French |journal=Rev Med Suisse |volume=8 |issue=337 |pages=848–53 |year=2012 |pmid=22594009 |doi= |url=}}</ref><ref name="pmid7555923">{{cite journal |vauthors=Sivri A, Hasçelik Z, Celiker R, Başgöze O |title=Early detection of neurological involvement in systemic lupus erythematosus patients |journal=Electromyogr Clin Neurophysiol |volume=35 |issue=4 |pages=195–9 |year=1995 |pmid=7555923 |doi= |url=}}</ref><ref name="pmid19217587">{{cite journal |vauthors=Juncal Gallego L, Almuíña Simón C, Muíños Esparza LF, Díaz Soto R, Ramil Fraga C, Quiroga Ordóñez E |title=[Systemic lupus erythematosus with fulminant neurological involvement] |language=Spanish; Castilian |journal=An Pediatr (Barc) |volume=70 |issue=2 |pages=202–4 |year=2009 |pmid=19217587 |doi=10.1016/j.anpedi.2008.09.009 |url=}}</ref>===
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| *Patient is usually oriented to persons, place, and time based on the disease course
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| *[[Cognitive impairment]]
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| *[[Hallucination|Hallucinations]]
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| **[[Visual hallucinations|Visual]]
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| **[[Auditory hallucinations|Auditory]]
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| *Memory deficit
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| **Loose associations
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| **Impoverished thought content
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| **Illogical thinking
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| **Bizarre disorganised or catatonic behaviour
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|
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|
| </div>}} | | </div>}} |