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SLE Serositis — RACP Adult Medicine MCQ

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EasyRheumatologySLE SerositisRACP Adult Medicine

A 42-year-old woman with known SLE on hydroxychloroquine and mycophenolate develops sudden onset pleuritic chest pain and dyspnoea. She is found to have bilateral pleural effusions and a pericardial effusion. Her complement levels are very low and anti-dsDNA has risen to 1:640. What is the most likely diagnosis?

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Correct answer: E — SLE serositis (lupus flare)

Serositis (pleuritis and/or pericarditis) is a common manifestation of SLE flare, occurring in ~50% of patients during their disease course. Active serological markers (high anti-dsDNA, low complement) support disease activity. Management includes increasing immunosuppression (corticosteroids ± NSAIDs for mild serositis). Large pericardial effusions causing tamponade require pericardiocentesis. Pulmonary embolism should also be considered given APS risk in SLE.

Reference: eTG – 2025 – Rheumatology; EULAR – 2023 – SLE Management Recommendations