Lupus Erythematosus: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
  • Inspection (viewing).
    • Skin (see table below)
    • Sclerae (white part of the eye)

    If four or more of the criteria in the table below are met (simultaneously or delayed), the diagnosis of systemic lupus erythematosus is made.

  • Auscultation (listening) of the heart.
  • Examination of the lungs (due topossible secondary diseases):
    • Auscultation (listening) of the lungs.
    • Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the physician listens to the lungs) [increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g., in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (attenuated or absent): e.g., in pleural effusion). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
    • Voice fremitus (check the transmission of low frequencies; the patient is asked to say several times in a low voice the word “99”, while the doctor puts his hands on the chest or back of the patient) [increased sound conduction due to pulmonary infiltration / compaction of lung tissue (eg, in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (greatly attenuated or absent: in pleural effusion). The consequence is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
  • Abdominal (stomach) examination [splenomegaly (splenomegaly)?]
    • Auscultation (listening) of the abdomen [vascular or stenotic sounds?]
    • Percussion (tapping) of the abdomen.
      • Meteorism (flatulence): hypersonoric tapping sound.
      • Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
      • Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size.
    • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?).
  • Dermatological examination [due todifferential diagnoses:
    • Acral vasculitis (inflammation of the small blood vessels on the acras (ends of the body)).
    • Actinic keratosis (changes on actinic (light) damaged skin; it can be the precursor to squamous cell carcinoma of the skin, which is why it is considered a precancerous lesion (precancerous lesions; KIN (keratinocytic intraepidermal neoplasia)).
    • Drug exanthema (rash caused by taking a drug).
    • Discoid lupus erythematosus
    • Erythema anulare centrifugum (bluish-red erythema that occurs as a skin reaction to multiple influences)
    • Erythema arciforme et palpabile
    • Erythema exsudativum multiforme (synonyms: erythema multiforme, cocard erythema, disc rose) – acute inflammation occurring in the upper corium (dermis), resulting in typical cocard-shaped lesions; a distinction is made between a minor and a major form.
    • Erythema gyratum repens (skin rash that often occurs with tumors of the internal organs).
    • Granuloma anulare (noninfectious granulomatous skin disease; coarse, ring-shaped, closely spaced, reddish nodules of the dermis).
    • Cutaneous mucinosis (accumulation of mucus in the skin area).
    • Light urticaria (appearance of wheals after exposure to light).
    • Nummular exanthema (rash with sharply defined disc-like redness of the skin).
    • Perioral dermatitis (synonyms: Erysipelas or Rosacea-like dermatitis) – skin disease with areal erythema (redness of skin), red disseminated or grouped follicular papules (nodular change on skin), pustules (pustules), dermatitis (skin inflammation) of the face, especially around the mouth (perioral), nose (perinasal) or eyes (periocular); Characteristic is that the skin zone adjacent to the red of the lips remains free; age between 20-45 years; mainly women are affected; risk factors are cosmetics, prolonged local corticosteroid therapy, ovulation inhibitors, sunlight
    • Polymorphous light dermatosis (multiple skin changes that occur after sun exposure to the skin).
    • Psoriasis vulgaris (psoriasis)
    • Rosacea (copper fins)
    • Seborrheic eczema (rash that occurs especially on the scalp and face and is associated with scaling).
    • Subacute cutaneous lupus erythematosus
    • Tinea corporis (chronic fungal skin disease affecting the entire body).
    • Tinea facei (chronic fungal skin disease affecting the face).
    • Toxic epidermal necrolysis (acute severe disease that leads to the destruction of the epidermis).
    • Viral exanthema (rash caused by viral infection)]
  • Ophthalmological examination [due topossible sequelae: Conjunctivitis (conjunctivitis), episcleritis (inflammation of the connective tissue layer of the liver skin)].
  • Cancer screening [due topossible sequelae: squamous cell carcinoma of the skin on scars of a discoid lupus erythematosus]
  • If necessary, neurological examination [due topossible sequelae: Aseptic meningitis (meningitis), myelopathy (spinal cord disease), polyneuropathy]
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.

(American Rheumatism Association (ARA) criteria for the diagnosis of SLE).