Mary

A 28-year-old woman of mixed heritage presents with 9 months of fatigue, bilateral hand stiffness worst in the mornings, hair thinning, oral ulcers and a malar rash triggered by sun exposure. Take a focused systemic history, examine appropriately, and formulate a diagnosis and management plan.

1. 1Take a focused history of the fatigue and joint symptoms using SOCRATES
2. 2Screen for multi-system SLE features: skin, hair, oral, eyes, renal, cardiorespiratory, neurological
3. 3Take a relevant past medical, family, medication and social history
4. 4Explore the photosensitive skin history and its timeline relative to symptoms
5. 5Verbalise a targeted physical and skin examination
6. 6Order appropriate immunological and organ-function investigations
7. 7State a working diagnosis with relevant differentials
8. 8Formulate a management plan including specialist referral and sun protection advice