SELF ASSESSMENT QUESTIONS Diagnostic issues in systemic lupus erythematosis

A 24 year old woman was diagnosed with systemic lupus erythematosis (SLE) based on a few months’ history of a photosensitive skin rash, predominantly on her face, arthralgia involving both hands and wrists, a positive antinuclear antibody (ANA) test and a raised antinative double stranded DNA antibody binding level. She was treated with oral hydroxychloroquine 400 mg daily and short courses of prednisolone during flare-ups. She was reviewed in clinic for her regular follow up appointment when she was found to be hypertensive on repeated measurements of her blood pressure, an average value being 150/90 mm Hg. She was also urine dipstick positive for blood and protein.