SLE — SCE Rheumatology MCQ

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EasyConnective tissue diseasesSLESCE Rheumatology

A 24-year-old woman has arthralgia, pleuritic chest pain and a photosensitive rash. Examination shows oral ulcers and a small knee effusion. Investigations show ANA 1:1280, positive anti-dsDNA antibodies, low C3 and a urine protein:creatinine ratio of 85 mg/mmol. What is the most likely diagnosis?

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Correct answer: E — Systemic lupus erythematosus

The diagnosis is systemic lupus erythematosus. She has compatible mucocutaneous disease, joint inflammation and probable serositis, together with proteinuria and the characteristic combination of anti-dsDNA antibodies and complement consumption. With ANA as the entry criterion, the renal, immunological and mucocutaneous features readily exceed the 2019 EULAR/ACR classification threshold, although diagnosis remains a clinical judgement. The raised urine protein:creatinine ratio requires prompt assessment for lupus nephritis. Mixed connective tissue disease is associated particularly with high-titre anti-U1 RNP, Raynaud phenomenon and swollen hands. Dermatomyositis should produce proximal weakness and characteristic cutaneous signs. Viral arthritis does not explain this renal and serological pattern. Adult-onset Still disease usually presents with quotidian fever and an evanescent rash and is typically ANA-negative.

Reference: Aringer M, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Annals of the Rheumatic Diseases. 2019;78:1151–1159. https://pubmed.ncbi.nlm.nih.gov/31383717/