Challenges in the diagnosis of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a lifelong, complex, multi-system, autoimmune condition which can occur at any age, most commonly in female adults in their reproductive years. Diagnosis is often delayed, with reported time from symptom onset to diagnosis as long as 6 years. Delayed diagnosis can result in irreversible organ damage, acute hospital admission, poor health-related outcomes and increased risk of mortality. SLE is a clinical diagnosis that requires a combination of clinical and immunological features attributable to lupus. Classification criteria have undergone several revisions and can be used to guide diagnosis. This article will review challenges in making a timely diagnosis of SLE, including heterogeneity of clinical and immunological features, disease mimickers, problems with diagnostic tests, and difficulties faced by general physicians and rheumatologists, with the aim to update knowledge among general physicians on clinical presentations and when to refer suspected patients to specialists.