Systemic Lupus Erythematosus — MFDS Part 1 MCQ

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ModerateHuman DiseaseSystemic Lupus ErythematosusMFDS Part 1

A 29-year-old woman has recurrent painless oral ulcers and symmetrical pain and morning stiffness affecting the small joints of both hands. Following sun exposure, she develops fixed erythema over both cheeks and the bridge of her nose, with sparing of the nasolabial folds. She has no proximal muscle weakness, skin thickening or persistent ocular and oral dryness. Which condition should be suspected?

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Correct answer: C — Systemic lupus erythematosus (SLE)

Systemic lupus erythematosus is the best answer. The discriminating combination is a photosensitive malar eruption across the cheeks and nasal bridge, recurrent oral ulcers and symmetrical inflammatory joint symptoms. Rheumatoid arthritis can cause symmetrical small-joint disease but does not characteristically produce this photosensitive facial eruption. Dermatomyositis would usually feature proximal muscle weakness with findings such as Gottron papules or a heliotrope eruption. Scleroderma is associated with skin thickening, Raynaud phenomenon and possible oesophageal dysfunction. Sjögren syndrome is dominated by persistent ocular and oral dryness. Serological tests may support suspected SLE, but diagnosis requires correlation of clinical and immunological findings; a positive antinuclear antibody alone is not diagnostic.

Reference: Guy's and St Thomas' NHS Foundation Trust. Raynaud's syndrome and scleroderma, section: Lupus (systemic lupus erythematosus). Reviewed July 2026. https://www.guysandstthomas.nhs.uk/health-information/raynauds-syndrome-and-scleroderma