Systemic Lupus Erythematosus and Overlap


  • Author- Wafa Qaisar, Tariq Waseem, Muhammad Awais Baloch


Connective tissue diseases are autoimmune in nature and have a predominance in younger to middle aged women. Symptoms sometimes can be so vague and ill-defined that it may take a while before they are correctly diagnosed and treatment offered Systemic Lupus Erythematosus (SLE) can have a very diverse clinical manifestation and may present without the typical history of a photosensitive rash, alopecia or oral ulcers. A 40-year-old lady presented to the outpatient department with complaints of joint pains, stiffness and unintentional weight loss of 6kgs. Complete blood picture showed pancytopenia but examination was unremarkable for lymphadenopathy and visceromegaly. A detailed assessment revealed hypothyroidism (TSH >100) along with a positive ENA profile with presence of Anti Ro/La, anti U1-RNP and Anti-Smith antibodies but no specific features of Mixed Connective Tissue Disorder. With low complement levels and positive Anti-DS-DNA antibodies she was labelled as SLE with Overlap and started on Replacement Thyroxine, Steroids and Disease Modifying Anti-Rheumatic Drugs (DMARDS). She showed significant improvement after 3 days of Pulse Therapy with Methylprednisolone and was discharged after 5 days of treatment with a follow up planned both with the Internist as well as the Rheumatologist.