What are the key clinical features to consider when diagnosing systemic lupus erythematosus (SLE) in a primary care setting?

When diagnosing systemic lupus erythematosus (SLE) in a primary care setting, key clinical features to consider include a combination of constitutional, mucocutaneous, musculoskeletal, and systemic symptoms. Patients often present with persistent fatigue, unexplained fever, and weight loss, which are nonspecific but important early signs. Mucocutaneous manifestations such as a malar rash (butterfly rash over the cheeks and nose), photosensitivity, oral or nasal ulcers, and alopecia are common and should raise suspicion. Musculoskeletal symptoms typically involve symmetrical polyarthritis or arthralgia without joint erosion. Systemic features may include serositis (pleuritis or pericarditis), renal involvement (proteinuria or haematuria), neurological symptoms (seizures or psychosis), and haematological abnormalities like anaemia, leukopenia, or thrombocytopenia. Additionally, a history of Raynaud’s phenomenon and positive antinuclear antibodies (ANA) support the diagnosis but require specialist confirmation. In primary care, recognizing this constellation of symptoms alongside risk factors such as female sex, childbearing age, and family history is crucial for early identification and referral for specialist assessment and immunological testing Pramanik 2014Choi et al. 2016NICE NG100.