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| ==Overview== | | ==Overview== |
| Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
| | Physical examination of patients with [[renal amyloidosis]] is usually remarkable for [[swelling]], [[hepatosplenomegaly]], facial or neck [[purpura]] and [[macroglossia]]. Fatigue and unintentional [[weight loss]], are common in patients with AL [[amyloidosis]]. [[Tachycardia]]/[[bradycardia]] depends on the accompanying [[complication]]. Pulmonary fine [[crackles]], faint pulmonary auscultation, suggestive of [[pleural effusion]], decreased [[tactile fremitus]] and dull percussion. |
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| OR
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| Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
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| OR
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| The presence of [finding(s)] on physical examination is diagnostic of [disease name].
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| OR
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| The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
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| ==Physical Examination== | | ==Physical Examination== |
| Physical examination of patients with [[renal amyloidosis]] is usually remarkable for [[swelling]], [[chronic renal failure]], [[hepatosplenomegaly]]<ref name="pmid7878478">{{cite journal |vauthors=Kyle RA, Gertz MA |title=Primary systemic amyloidosis: clinical and laboratory features in 474 cases |journal=Semin. Hematol. |volume=32 |issue=1 |pages=45–59 |date=January 1995 |pmid=7878478 |doi= |url=}}</ref>, [[facial or neck purpura]] and [[macroglossia]]<ref name="pmid17554122">{{cite journal |vauthors=Eder L, Bitterman H |title=Image in clinical medicine. Amyloid purpura |journal=N. Engl. J. Med. |volume=356 |issue=23 |pages=2406 |date=June 2007 |pmid=17554122 |doi=10.1056/NEJMicm061510 |url=}}</ref>. Fatigue and unintentional weight loss, are common in patients with AL amyloidosis. <ref name="pmid23227278">{{cite journal |vauthors=Baker KR, Rice L |title=The amyloidoses: clinical features, diagnosis and treatment |journal=Methodist Debakey Cardiovasc J |volume=8 |issue=3 |pages=3–7 |date=2012 |pmid=23227278 |pmc=3487569 |doi= |url=}}</ref><ref name="pmid8331978">{{cite journal |vauthors=Menke DM, Kyle RA, Fleming CR, Wolfe JT, Kurtin PJ, Oldenburg WA |title=Symptomatic gastric amyloidosis in patients with primary systemic amyloidosis |journal=Mayo Clin. Proc. |volume=68 |issue=8 |pages=763–7 |date=August 1993 |pmid=8331978 |doi= |url=}}</ref> | | Physical examination of patients with [[renal amyloidosis]] is usually remarkable for [[swelling]], [[hepatosplenomegaly]], [[facial or neck purpura]] and [[macroglossia]]. Fatigue and unintentional weight loss, are common in patients with AL amyloidosis. <ref name="pmid23227278">{{cite journal |vauthors=Baker KR, Rice L |title=The amyloidoses: clinical features, diagnosis and treatment |journal=Methodist Debakey Cardiovasc J |volume=8 |issue=3 |pages=3–7 |date=2012 |pmid=23227278 |pmc=3487569 |doi= |url=}}</ref><ref name="pmid8331978">{{cite journal |vauthors=Menke DM, Kyle RA, Fleming CR, Wolfe JT, Kurtin PJ, Oldenburg WA |title=Symptomatic gastric amyloidosis in patients with primary systemic amyloidosis |journal=Mayo Clin. Proc. |volume=68 |issue=8 |pages=763–7 |date=August 1993 |pmid=8331978 |doi= |url=}}</ref><ref name="pmid7878478">{{cite journal |vauthors=Kyle RA, Gertz MA |title=Primary systemic amyloidosis: clinical and laboratory features in 474 cases |journal=Semin. Hematol. |volume=32 |issue=1 |pages=45–59 |date=January 1995 |pmid=7878478 |doi= |url=}}</ref><ref name="pmid17554122">{{cite journal |vauthors=Eder L, Bitterman H |title=Image in clinical medicine. Amyloid purpura |journal=N. Engl. J. Med. |volume=356 |issue=23 |pages=2406 |date=June 2007 |pmid=17554122 |doi=10.1056/NEJMicm061510 |url=}}</ref> |
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| ===Appearance of the Patient=== | | ===Appearance of the Patient=== |
| *Patient appears well in the earlier stages of the disease | | *Patient appears well in the earlier stages of the disease<ref name="pmid23608605">{{cite journal |vauthors=Pinney JH, Whelan CJ, Petrie A, Dungu J, Banypersad SM, Sattianayagam P, Wechalekar A, Gibbs SD, Venner CP, Wassef N, McCarthy CA, Gilbertson JA, Rowczenio D, Hawkins PN, Gillmore JD, Lachmann HJ |title=Senile systemic amyloidosis: clinical features at presentation and outcome |journal=J Am Heart Assoc |volume=2 |issue=2 |pages=e000098 |date=April 2013 |pmid=23608605 |pmc=3647259 |doi=10.1161/JAHA.113.000098 |url=}}</ref> |
| *Patient appears ill in the late stages of the disease due to multi-organ involvement | | *Patient appears ill in the late stages of the disease due to multi-organ involvement<ref name="pmid27099136">{{cite journal |vauthors=Nishi S, Ubara Y, Utsunomiya Y, Okada K, Obata Y, Kai H, Kiyomoto H, Goto S, Konta T, Sasatomi Y, Sato Y, Nishino T, Tsuruya K, Furuichi K, Hoshino J, Watanabe Y, Kimura K, Matsuo S |title=Evidence-based clinical practice guidelines for nephrotic syndrome 2014 |journal=Clin. Exp. Nephrol. |volume=20 |issue=3 |pages=342–70 |date=June 2016 |pmid=27099136 |pmc=4891386 |doi=10.1007/s10157-015-1216-x |url=}}</ref> |
| ===Vital Signs=== | | ===Vital Signs=== |
| *[[Fever]] higher than 38 after the exclusion of [[infection]] | | *[[Fever]] depends on accompanying [[infection]] |
| *[[Tachycardia]]/[[bradycardia]] depends on the accompanying complication | | *[[Tachycardia]]/[[bradycardia]] depends on the accompanying complication<ref name="pmid23608605">{{cite journal |vauthors=Pinney JH, Whelan CJ, Petrie A, Dungu J, Banypersad SM, Sattianayagam P, Wechalekar A, Gibbs SD, Venner CP, Wassef N, McCarthy CA, Gilbertson JA, Rowczenio D, Hawkins PN, Gillmore JD, Lachmann HJ |title=Senile systemic amyloidosis: clinical features at presentation and outcome |journal=J Am Heart Assoc |volume=2 |issue=2 |pages=e000098 |date=April 2013 |pmid=23608605 |pmc=3647259 |doi=10.1161/JAHA.113.000098 |url=}}</ref> |
| *[[Tachypnea]]/[[bradypnea]] depends on the accompanying complication
| | *[[Tachypnea]]/[[bradypnea]] depends on the accompanying complication<ref name="pmid27099136">{{cite journal |vauthors=Nishi S, Ubara Y, Utsunomiya Y, Okada K, Obata Y, Kai H, Kiyomoto H, Goto S, Konta T, Sasatomi Y, Sato Y, Nishino T, Tsuruya K, Furuichi K, Hoshino J, Watanabe Y, Kimura K, Matsuo S |title=Evidence-based clinical practice guidelines for nephrotic syndrome 2014 |journal=Clin. Exp. Nephrol. |volume=20 |issue=3 |pages=342–70 |date=June 2016 |pmid=27099136 |pmc=4891386 |doi=10.1007/s10157-015-1216-x |url=}}</ref> |
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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> ===
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| *[[Cyanosis]]
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| **Secondary to [[respiratory]] complications
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| *[[Jaundice]]
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| **Secondary to [[hepatitis]]
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| *[[Pallor]]
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| **Secondary to [[anemia]]
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| *Generalised [[erythema]]
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| *[[Bruises]]
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| **Secondary to [[thrombocytopenia]]
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| *[[Urticaria]]
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| *[[Bullous|Bullous lesions]]
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| *[[Sclerodactyly]]
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| *Skin [[Ulcerations|ulceration]]
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| *[[Malar rash]]: the classic lupus ‘butterfly’ rash
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| ** [[Erythema|Erythematous]], elevated [[Lesions|lesion]], [[Pruritis|pruritic]] or painful, in a [[malar]] distribution, commonly precipitated by exposure to sunlight
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| * Annular or psoriasiform skin [[lesions]]
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| ** 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
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| * [[Scarring]] [[chronic]] [[alopecia]]
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| ** Mostly present on face, neck, and scalp
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| * [[Telangiectasias]]
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| * Dyspigmentation ([[hyperpigmentation]] or [[hypopigmentation]]) of skin in [[scar]] places
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| * Follicular plugging
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| ** Discrete, [[erythematous]], slightly infiltrated [[plaques]] covered by a well-formed adherent scale that extends into dilated [[hair follicles]]
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| * [[Nodules]]
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| ** Can be firm (Lupus profundus) and painful
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| * Photodistributed [[lesions]] with chronic pink indurated plaques or broad [[lesions]] that are slow to heal (more seen in lupus tumidus)
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| * Thin hair that easily fractures (lupus hair)
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| * 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]]
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| * Periungual [[erythema]]
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| ** Dilated tortuous loops of [[capillaries]] and a prominent subcapillary venous plexus along
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| ** Involves the base of the nail and edges of the upper [[eyelid]]
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| [[File:Systemic lupus erythematosus 055.jpg|300px]]
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| '''For more pictures of the rash presentation in lupus, click [[Systemic lupus eryhthematosus physical examination:Gallery|here]].'''
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| ===HEENT===
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| *[[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>
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| **[[Nystagmus]]
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| **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]])
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| **[[Cataract]]
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| **[[Optic nerve atrophy]]
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| **[[Icterus|Icteric sclera]]
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| **[[Cotton wool spots]] in the [[retina]] in [[Ophthalmoscopy|ophthalmoscopic exam]]
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| *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>
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| **Mostly painless
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| **Mostly in lower [[nasal septum]] and [[bilateral]] and parallel
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| **Nasal perforation secondary to [[vasculitis]] may happen rarely
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| *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>
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| **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>===
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| *[[Jugular venous distension]]
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| **Secondary to [[hypertension]] and cardiac complications
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| *[[Lymphadenopathy]]
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| ** [[Lymph node|Lymph nodes]] are soft, non-tender, discrete
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| ** 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>===
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| *Fine and coarse [[crackles]] upon auscultation of the [[lung]]
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| **May be due to [[pneumonitis]]
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| *In case of [[pleural effusion]]:
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| **Asymmetric [[tactile fremitus]]
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| **Asymmetric [[chest expansion]]
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| ===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>===
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| *Chest [[tenderness]] or discomfort upon palpation
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| **May be due to [[costochondritis]]
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| *[[Diastolic murmurs|Diastolic murmur]], or [[Systolic murmurs|systolic murmur]] >3/6 due to [[valvular disease]]
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| *Loud second heart sound (due to [[pulmonary hypertension]])
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| *Loud S1-S2 due to [[cardiomegaly]]
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| *Decrease heart sounds if associated with [[pericardial effusion]]
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| ===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>=== | | === Skin === |
| *[[Abdominal distention]]
| | *[[Bruises|Pupura]] <ref name="pmid175541222">{{cite journal |vauthors=Eder L, Bitterman H |title=Image in clinical medicine. Amyloid purpura |journal=N. Engl. J. Med. |volume=356 |issue=23 |pages=2406 |date=June 2007 |pmid=17554122 |doi=10.1056/NEJMicm061510 |url=}}</ref> |
| *[[Ascites]]
| | ===Eyes=== |
| **Due to [[nephrotic syndrome]]
| | * [[Periorbital edema]]<ref name="pmid23608605">{{cite journal |vauthors=Pinney JH, Whelan CJ, Petrie A, Dungu J, Banypersad SM, Sattianayagam P, Wechalekar A, Gibbs SD, Venner CP, Wassef N, McCarthy CA, Gilbertson JA, Rowczenio D, Hawkins PN, Gillmore JD, Lachmann HJ |title=Senile systemic amyloidosis: clinical features at presentation and outcome |journal=J Am Heart Assoc |volume=2 |issue=2 |pages=e000098 |date=April 2013 |pmid=23608605 |pmc=3647259 |doi=10.1161/JAHA.113.000098 |url=}}</ref> |
| *[[Abdominal pain]]
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| **Due to [[Vasculitis|mesentric vasculitis]]
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| *[[Hepatomegaly]]
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| *[[Splenomegaly]]
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| *Costo-vertebral angle tenderness
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|
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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>=== | | ===Lungs=== |
| *[[Clubbing]] | | *Pulmonary fine [[crackles]] |
| *[[Cyanosis]]
| | *Faint pulmonary auscultation, suggestive of [[pleural effusion]] |
| *[[Muscle weakness|Muscle atrophy or weakness]] | | *Decreased [[tactile fremitus]] |
| *[[Livedo reticularis]]
| | *Dull percussion<ref name="pmid27099136">{{cite journal |vauthors=Nishi S, Ubara Y, Utsunomiya Y, Okada K, Obata Y, Kai H, Kiyomoto H, Goto S, Konta T, Sasatomi Y, Sato Y, Nishino T, Tsuruya K, Furuichi K, Hoshino J, Watanabe Y, Kimura K, Matsuo S |title=Evidence-based clinical practice guidelines for nephrotic syndrome 2014 |journal=Clin. Exp. Nephrol. |volume=20 |issue=3 |pages=342–70 |date=June 2016 |pmid=27099136 |pmc=4891386 |doi=10.1007/s10157-015-1216-x |url=}}</ref> |
| **Reddish-cyanotic, reticular pattern on the skin of the arms, legs, and torso, particularly with cold exposure
| | ===Abdomen=== |
| *[[Arthritis]]
| | * [[Abdominal distension]] |
| **Symmetrical
| | *Shifting dullness, suggestive of [[ascites]] |
| **Polyarticular
| | *Dull percussion |
| **Mostly involve knees, carpal joints, and joints of the fingers, especially the proximal [[interphalangeal]] (PIP) joint
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| **Decrease range of motion in affected joints | |
| *Joints [[erythema]]
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| **Due to [[synovitis]]
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| *Joint effusion
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| *Muscle [[atrophy]]
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| *[[Fasciculations]] in the upper/lower extremity
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| *[[Claudication]]
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| *Loss of digit or limb
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|
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| ===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>=== | | ===Extremities=== |
| *Patient is usually oriented to persons, place, and time based on the disease course
| | *[[Pitting edema]] in lower extremities bilaterally |
| *[[Cognitive impairment]] | |
| *[[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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| ==References== | | ==References== |