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| __NOTOC__
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| {{Systemic lupus erythematosus}}
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| {{CMG}}; {{AE}} {{MIR}}
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| ==Overview==
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| A positive history of familial [[lupus]], [[skin rashes]] (especially [[Photosensitivity|photosensitive]] [[skin rashes]]), [[arthritis]], and [[fatigue]] may be suggestive of [[systemic lupus erythematosus]]. The most common symptoms of [[SLE]] include constitutional symptoms like [[fatigue]], [[fever]], [[myalgia]], and [[Weight|weight changes]]. Other organ-specific symptoms mostly occur with disease progression. [[SLE]] may show a variety of symptoms in different organs depending on its complications.
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| ==History==
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| Obtaining the history is one of the most important aspects in making a diagnosis of [[systemic lupus erythematosus]]. It provides insight into disease course and severity, precipitating risk factors, and associated [[comorbid]] conditions. Complete history will help determine the correct complication diagnosis, and helps in determining the prognosis as well. Specific histories about the symptoms (duration, onset, progression), associated symptoms, and [[drug]] usage have to be obtained. Specific areas of focus when obtaining the history are outlined below:
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| * Onset, duration and progression of symptoms
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| * History of [[Weight change|weight changes]] (gain or loss)
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| * [[Anorexia]]
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| * [[Arthritis]], [[Arthralgia|arthralgias]], or [[muscle pain]]
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| * Morning [[stiffness]]
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| * [[Skin rashes]] and their association to flare ups, especially after exposure to sunlight
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| * [[Medications]] and their association to flare ups
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| * [[Infections]] especially [[mononucleosis]]
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| * Sores in the mouth, nose, or other [[Mucous membrane|mucous membranes]]
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| * Symptoms of other organ failure
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| ** [[Renal failure]]: Recent peripheral [[edema]] and [[weight gain]]
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| ** [[Cardiac]] involvement: [[Tachycardia]], [[dyspnea]], [[Chest pain|chest pains]]
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| * History of having a pet
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| * [[Hair loss]]
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| * Job history
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| * [[Comorbid|Co-morbid]] conditions include:
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| ** Other [[Rheumatologic disease|rheumatologic]] and [[autoimmune diseases]]
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| ** [[Hypertension]]
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| ** [[Diabetes]], [[immunodeficiency]]
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| * [[Seizure|Seizures]], or other [[nervous system]] symptoms
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| * [[Family history]] of [[Rheumatologic disease|rheumatologic diseases]]
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| == Common Symptoms ==
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| The early manifestations of [[systemic lupus erythematosus]] include common constitutional symptoms that may be seen in many other diseases as well:<ref name="pmid11085805">{{cite journal |vauthors=Tench CM, McCurdie I, White PD, D'Cruz DP |title=The prevalence and associations of fatigue in systemic lupus erythematosus |journal=Rheumatology (Oxford) |volume=39 |issue=11 |pages=1249–54 |year=2000 |pmid=11085805 |doi= |url=}}</ref><ref name="pmid7779127">{{cite journal |vauthors=McKinley PS, Ouellette SC, Winkel GH |title=The contributions of disease activity, sleep patterns, and depression to fatigue in systemic lupus erythematosus. A proposed model |journal=Arthritis Rheum. |volume=38 |issue=6 |pages=826–34 |year=1995 |pmid=7779127 |doi= |url=}}</ref><ref name="pmid9598886">{{cite journal |vauthors=Wang B, Gladman DD, Urowitz MB |title=Fatigue in lupus is not correlated with disease activity |journal=J. Rheumatol. |volume=25 |issue=5 |pages=892–5 |year=1998 |pmid=9598886 |doi= |url=}}</ref>
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| *[[Fatigue]]
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| *[[Fever]]
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| *[[Myalgia]]
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| *Joint [[tenderness]]
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| *[[Muscle weakness]]
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| *[[Weight]] change
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| **[[Weight gain]] due to increase in [[water retention]] and increase in appetite
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| **[[Weight loss]] due to medication side effect and gastrointestinal problems
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|
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| == Less Common Symptoms ==
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|
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| === Organ system based signs and symptoms ===
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| * Symptoms in the below table are listed based on their frequency in each organ system and the disease that is responsible for each symptom:<ref name="pmid14530779">{{cite journal |vauthors=Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Mejía JC, Aydintug AO, Chwalinska-Sadowska H, de Ramón E, Fernández-Nebro A, Galeazzi M, Valen M, Mathieu A, Houssiau F, Caro N, Alba P, Ramos-Casals M, Ingelmo M, Hughes GR |title=Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients |journal=Medicine (Baltimore) |volume=82 |issue=5 |pages=299–308 |year=2003 |pmid=14530779 |doi=10.1097/01.md.0000091181.93122.55 |url=}}</ref><ref name="pmid2319520">{{cite journal |vauthors=Finol HJ, Montagnani S, Márquez A, Montes de Oca I, Müller B |title=Ultrastructural pathology of skeletal muscle in systemic lupus erythematosus |journal=J. Rheumatol. |volume=17 |issue=2 |pages=210–9 |year=1990 |pmid=2319520 |doi= |url=}}</ref><ref name="pmid20572299">{{cite journal |vauthors=Tian XP, Zhang X |title=Gastrointestinal involvement in systemic lupus erythematosus: insight into pathogenesis, diagnosis and treatment |journal=World J. Gastroenterol. |volume=16 |issue=24 |pages=2971–7 |year=2010 |pmid=20572299 |pmc=2890936 |doi= |url=}}</ref><ref name="pmid27329649">{{cite journal |vauthors=Alves SC, Fasano S, Isenberg DA |title=Autoimmune gastrointestinal complications in patients with systemic lupus erythematosus: case series and literature review |journal=Lupus |volume=25 |issue=14 |pages=1509–1519 |year=2016 |pmid=27329649 |doi=10.1177/0961203316655210 |url=}}</ref><ref name="pmid27055518">{{cite journal |vauthors=Fawzy M, Edrees A, Okasha H, El Ashmaui A, Ragab G |title=Gastrointestinal manifestations in systemic lupus erythematosus |journal=Lupus |volume=25 |issue=13 |pages=1456–1462 |year=2016 |pmid=27055518 |doi=10.1177/0961203316642308 |url=}}</ref><ref name="pmid28523968">{{cite journal |vauthors=Li Z, Xu D, Wang Z, Wang Y, Zhang S, Li M, Zeng X |title=Gastrointestinal system involvement in systemic lupus erythematosus |journal=Lupus |volume= |issue= |pages=961203317707825 |year=2017 |pmid=28523968 |doi=10.1177/0961203317707825 |url=}}</ref><ref name="pmid26550810">{{cite journal |vauthors=Salvati F |title=[The involvement of pulmonary interstitial tissue in multisystemic lupus erythematosus: interdisciplinarity and role of the pneumologists] |language=Italian |journal=Clin Ter |volume=166 |issue=5 |pages=205–7 |year=2015 |pmid=26550810 |doi= |url=}}</ref><ref name="pmid21194884">{{cite journal |vauthors=Torre O, Harari S |title=Pleural and pulmonary involvement in systemic lupus erythematosus |journal=Presse Med |volume=40 |issue=1 Pt 2 |pages=e19–29 |year=2011 |pmid=21194884 |doi=10.1016/j.lpm.2010.11.004 |url=}}</ref><ref name="pmid25639532">{{cite journal |vauthors=Alamoudi OS, Attar SM |title=Pulmonary manifestations in systemic lupus erythematosus: association with disease activity |journal=Respirology |volume=20 |issue=3 |pages=474–80 |year=2015 |pmid=25639532 |pmc=4418345 |doi=10.1111/resp.12473 |url=}}</ref><ref name="pmid25458514">{{cite journal |vauthors=Finucci Curi P, Pierrestegui M, Ortiz A, Ceccato F, Paira S |title=[Pulmonary hemorrhage in patients with systemic lupus erythematosus. Clinical manifestations and prognosis] |language=Spanish; Castilian |journal=Med Clin (Barc) |volume=145 |issue=9 |pages=375–9 |year=2015 |pmid=25458514 |doi=10.1016/j.medcli.2014.07.034 |url=}}</ref><ref name="pmid24790989">{{cite journal |vauthors=Mak A, Kow NY |title=Imbalance between endothelial damage and repair: a gateway to cardiovascular disease in systemic lupus erythematosus |journal=Biomed Res Int |volume=2014 |issue= |pages=178721 |year=2014 |pmid=24790989 |pmc=3984775 |doi=10.1155/2014/178721 |url=}}</ref><ref name="pmid24722263">{{cite journal |vauthors=Sacre K, Escoubet B, Pasquet B, Chauveheid MP, Zennaro MC, Tubach F, Papo T |title=Increased arterial stiffness in systemic lupus erythematosus (SLE) patients at low risk for cardiovascular disease: a cross-sectional controlled study |journal=PLoS ONE |volume=9 |issue=4 |pages=e94511 |year=2014 |pmid=24722263 |pmc=3983200 |doi=10.1371/journal.pone.0094511 |url=}}</ref><ref name="pmid23052654">{{cite journal |vauthors=Canpolat N, Kasapcopur O, Caliskan S, Gokalp S, Bor M, Tasdemir M, Sever L, Arisoy N |title=Ambulatory blood pressure and subclinical cardiovascular disease in patients with juvenile-onset systemic lupus erythematosus |journal=Pediatr. Nephrol. |volume=28 |issue=2 |pages=305–13 |year=2013 |pmid=23052654 |doi=10.1007/s00467-012-2317-3 |url=}}</ref><ref name="pmid19366083">{{cite journal |vauthors=Cojocaru IM, Cojocaru M, Tănăsescu R, Burcin C, Atanasiu AN, Silosi I |title=Detection of autoantibodies to ribosome P in lupus patients with neurological involvement |journal=Rom J Intern Med |volume=46 |issue=3 |pages=239–42 |year=2008 |pmid=19366083 |doi= |url=}}</ref><ref name="pmid22594009">{{cite journal |vauthors=Madrane S, Ribi C |title=[Central neuropsychiatric involvement in systemic lupus erythematosus] |language=French |journal=Rev Med Suisse |volume=8 |issue=337 |pages=848–53 |year=2012 |pmid=22594009 |doi= |url=}}</ref><ref name="pmid7555923">{{cite journal |vauthors=Sivri A, Hasçelik Z, Celiker R, Başgöze O |title=Early detection of neurological involvement in systemic lupus erythematosus patients |journal=Electromyogr Clin Neurophysiol |volume=35 |issue=4 |pages=195–9 |year=1995 |pmid=7555923 |doi= |url=}}</ref><ref name="pmid19217587">{{cite journal |vauthors=Juncal Gallego L, Almuíña Simón C, Muíños Esparza LF, Díaz Soto R, Ramil Fraga C, Quiroga Ordóñez E |title=[Systemic lupus erythematosus with fulminant neurological involvement] |language=Spanish; Castilian |journal=An Pediatr (Barc) |volume=70 |issue=2 |pages=202–4 |year=2009 |pmid=19217587 |doi=10.1016/j.anpedi.2008.09.009 |url=}}</ref><ref name="pmid22192934">{{cite journal |vauthors=Karras A |title=[Renal involvement in systemic lupus erythematosus] |language=French |journal=Presse Med |volume=41 |issue=3 Pt 1 |pages=260–6 |year=2012 |pmid=22192934 |doi=10.1016/j.lpm.2011.11.006 |url=}}</ref><ref name="pmid25548784">{{cite journal |vauthors=Kiremitci S, Ensari A |title=Classifying lupus nephritis: an ongoing story |journal=ScientificWorldJournal |volume=2014 |issue= |pages=580620 |year=2014 |pmid=25548784 |pmc=4274910 |doi=10.1155/2014/580620 |url=}}</ref><ref name="pmid15580980">{{cite journal |vauthors=Zoma A |title=Musculoskeletal involvement in systemic lupus erythematosus |journal=Lupus |volume=13 |issue=11 |pages=851–3 |year=2004 |pmid=15580980 |doi=10.1191/0961203303lu2021oa |url=}}</ref><ref name="pmid22956550">{{cite journal |vauthors=Gabba A, Piga M, Vacca A, Porru G, Garau P, Cauli A, Mathieu A |title=Joint and tendon involvement in systemic lupus erythematosus: an ultrasound study of hands and wrists in 108 patients |journal=Rheumatology (Oxford) |volume=51 |issue=12 |pages=2278–85 |year=2012 |pmid=22956550 |doi=10.1093/rheumatology/kes226 |url=}}</ref><ref name="pmid19591780">{{cite journal |vauthors=Grossman JM |title=Lupus arthritis |journal=Best Pract Res Clin Rheumatol |volume=23 |issue=4 |pages=495–506 |year=2009 |pmid=19591780 |doi=10.1016/j.berh.2009.04.003 |url=}}</ref><ref name="pmid24862229">{{cite journal |vauthors=Zhu KK, Xu WD, Pan HF, Zhang M, Ni J, Ge FY, Ye DQ |title=The risk factors of avascular necrosis in patients with systemic lupus erythematosus: a meta-analysis |journal=Inflammation |volume=37 |issue=5 |pages=1852–64 |year=2014 |pmid=24862229 |doi=10.1007/s10753-014-9917-y |url=}}</ref><ref name="pmid23731640">{{cite journal |vauthors=Voulgari PV, Kosta P, Argyropoulou MI, Drosos AA |title=Avascular necrosis in a patient with systemic lupus erythematosus |journal=Joint Bone Spine |volume=80 |issue=6 |pages=665 |year=2013 |pmid=23731640 |doi=10.1016/j.jbspin.2013.03.018 |url=}}</ref><ref name="pmid25077888">{{cite journal |vauthors=Parodi A, Cozzani E |title=Cutaneous manifestations of lupus erythematosus |journal=G Ital Dermatol Venereol |volume=149 |issue=5 |pages=549–54 |year=2014 |pmid=25077888 |doi= |url=}}</ref><ref name="pmid26985173">{{cite journal |vauthors=Szczęch J, Rutka M, Samotij D, Zalewska A, Reich A |title=Clinical characteristics of cutaneous lupus erythematosus |journal=Postepy Dermatol Alergol |volume=33 |issue=1 |pages=13–7 |year=2016 |pmid=26985173 |pmc=4793050 |doi=10.5114/pdia.2014.44031 |url=}}</ref><ref name="pmid19824738">{{cite journal |vauthors=Walling HW, Sontheimer RD |title=Cutaneous lupus erythematosus: issues in diagnosis and treatment |journal=Am J Clin Dermatol |volume=10 |issue=6 |pages=365–81 |year=2009 |pmid=19824738 |doi=10.2165/11310780-000000000-00000 |url=}}</ref>
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| {| class="wikitable"
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| ! style="background: #4479BA; color: #FFFFFF; " |Organ system
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| ! style="background: #4479BA; color: #FFFFFF; " |Disease
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| ! style="background: #4479BA; color: #FFFFFF; " |Symptom
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| |-
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| | rowspan="7" |<small>[[Gastrointestinal]]</small>
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| | style="background: #DCDCDC; " |[[Dysphagia]]
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| * Retrosternal [[chest pain]]
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| * [[Heartburn]]
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| * [[Regurgitation]]
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| * [[Odynophagia]]
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| |-
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| | style="background: #DCDCDC; " |[[Peptic ulcer disease]]
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| * [[Epigastric pain]]
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| * Food-provoked [[Discomfort|epigastric discomfort]] and fullness
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| * Early satiety
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| * [[Nausea]]
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| |-
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| | style="background: #DCDCDC; " |[[Intestinal pseudo obstruction|Intestinal pseudo-obstruction]]
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| * [[Abdominal pain]]
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| * [[Bloating]]
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| * [[Distension]]
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| |-
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| | style="background: #DCDCDC; " |[[Protein losing enteropathy|Protein-losing enteropathy]]
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| * Profound [[edema]]
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| * Severe [[diarrhea]]
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| |-
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| | style="background: #DCDCDC; " |[[Acute pancreatitis]]
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| * Severe persistent [[epigastric pain]] often radiating to the back
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| |-
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| | style="background: #DCDCDC; " |[[Vasculitis|Mesenteric vasculitis]]
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| * [[Abdominal pain]]
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| * Food aversion
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| * [[Weight loss]]
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| * [[Nausea]]
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| * [[Vomiting]]
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| * [[Diarrhea]]
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| ** Due to chronic [[mesenteric ischemia]]
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| |-
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| | style="background: #DCDCDC; " |[[Peritonitis]]
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| * Abdominal [[bloating]] or [[Abdominal distension|distension]]
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| * [[Nausea and vomiting]]
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| * [[Constipation]] or the inability to pass gas
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| * [[Anorexia]]
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| * [[Abdominal pain]]
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| |-
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| | rowspan="7" |<small>[[Pulmonary]]</small>
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| | style="background: #DCDCDC; " |[[Pleural disease]]
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| * [[Cough]]
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| * [[Dyspnea]]
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| * [[Fever]]
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| |-
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| | style="background: #DCDCDC; " |[[Pneumonitis]]
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| * [[Fever]]
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| * [[Cough]] (sometimes with hemoptysis)
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| * [[Dyspnea]]
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| |-
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| | style="background: #DCDCDC; " |[[Pulmonary hemorrhage]]
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| * [[Dyspnea]]
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| * [[Cough]]
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| * [[Hemoptysis]]
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| |-
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| | style="background: #DCDCDC; " |[[Interstitial lung disease]]
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| * May be [[asymptomatic]]
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| * Chronic nonproductive [[cough]]
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| * [[Dyspnea]]
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| * Decreased [[Exercise tolerance test|exercise tolerance]]
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| |-
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| | style="background: #DCDCDC; " |[[Pulmonary emboli]]
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| * [[Dyspnea]]
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| * Sharp [[chest pain]] that may become worse with deep breathing or [[Cough|coughing]]
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| |-
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| | style="background: #DCDCDC; " |[[Pulmonary hypertension]]
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| * [[Dyspnea]]
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| * [[Palpitation|Palpitations]]
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| * [[Fatigue]]
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| * Impaired [[Exercise tolerance test|exercise tolerance]]
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| * [[Weakness]]
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| * [[Syncope]]
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| * [[Edema]]
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| * Increased abdominal girth
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| |-
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| | style="background: #DCDCDC; " |Shrinking lung syndrome
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| * [[Dyspnea]]
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| * [[Pleuritic chest pain]] (episodic)
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| |-
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| | rowspan="4" |<small>[[Cardiac]]</small>
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| | style="background: #DCDCDC; " |[[Valvular disease]]
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| * [[Tachycardia]]
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| * [[Syncope]]
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| * [[Dyspnea]]
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| * [[Peripheral edema]]
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| |-
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| | style="background: #DCDCDC; " |[[Pericarditis]]
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| * Sharp, stabbing [[chest pain]] with a sudden start
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| * Positional pain that decreases when sitting up and leaning forward
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| |-
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| | style="background: #DCDCDC; " |[[Myocarditis]]
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| * [[Tachycardia]]
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| * [[Fever]] and chills
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| |-
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| | style="background: #DCDCDC; " |[[Coronary heart disease]]
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| * [[Chest pain]]
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| * [[Dyspnea]]
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| * [[Nausea and vomiting]]
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| |-
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| | rowspan="4" |<small>[[Neurological disorders|Neurological]]</small>
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| | style="background: #DCDCDC; " |CNS small vessle [[vasculitis]]
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| * [[Cognitive impairment]]
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| * [[Headache]]
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| |-
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| | style="background: #DCDCDC; " |[[Stroke]]
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| * [[Speech disturbances|Speech disturbance]]
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| * [[Weakness]] on one-half of the body
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| |-
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| | style="background: #DCDCDC; " |[[Seizure|Seizures]]
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| * [[Tonic-clonic seizure]]
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| |-
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| | style="background: #DCDCDC; " |[[Psychosis]]
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| * [[Hallucination|Hallucinations]]
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| ** [[Visual hallucinations|Visual]]
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| ** [[Auditory hallucinations|Auditory]]
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| |-
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| |<small>[[Genitourinary system|Genitourinary]]</small>
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| | style="background: #DCDCDC; " |[[Nephrotic syndrome]]
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| * [[Hypertension]]
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| * [[Peripheral edema]]
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| * Foamy [[urine]]
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| * [[Weight gain]]
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| |-
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| | rowspan="3" |<small>[[Musculoskeletal]]</small>
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| | style="background: #DCDCDC; " |[[Arthritis]]
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| * Mostly symmetrical
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| * [[Arthralgias]]
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| * Decreased [[range of motion]] of both small and large joints
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| * Morning [[stiffness]] that will last less than 1 hour
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| |-
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| | style="background: #DCDCDC; " |[[Avascular necrosis]]
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| * [[Asymptomatic]]
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| * Mild to moderate pain in [[groin]] and lower abdomen in case of femoral head [[AVN]]
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| * Secondary pain amplification
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| |-
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| | style="background: #DCDCDC; " |[[Osteoporosis]]
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| * Loss of height
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| * Sudden [[back pain]]
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| |-
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| | rowspan="4" |<small>[[Skin]] disorder</small>
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| | style="background: #DCDCDC; " |[[Cutaneous lupus erythematosus]]
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| * [[Malar rash]]
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| * Generalized [[maculopapular rash]]
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| * [[Discoid lupus|Discoid]] [[rash]]
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| * [[Bullous]] [[lesions]]
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| * [[Raynaud's phenomenon]]
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| * [[Pyoderma gangrenosum]]
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| ** Ulcerative cutaneous condition
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| * [[Erythema multiforme]]
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| * Nail fold infarcts
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| |-
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| | style="background: #DCDCDC; " |[[Photosensitivity]]
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| * Common theme for skin [[lesions]] associated with [[SLE]]
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| |-
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| | style="background: #DCDCDC; " |[[Oral ulcer|Oral]] and nasal ulcers
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| |
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| * Usually painless
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| |-
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| | style="background: #DCDCDC; " |[[Alopecia|Nonscarring alopecia]]
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| * May occur at some point during the course of their disease
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| |}
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|
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| ==References==
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| {{Reflist|2}}
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|
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| [[Category:Arthritis]] | | [[Category:Arthritis]] |