A new case:
24 years old hypertensive Girl complaining of fatigue, dizziness, paroxysmal nocturnal dyspnea, palpitation, joint pain, photosensitivity, oral ulcer, hands deformities, hair loss and weight loss 15 to 20 kg within 6 months with past history of taking aspirin and ketofen due to her headache from 16 years old till 24 years. In the first time, with two complain of fatigue and dizziness has been treated with folic acid, iron and calcium but no improvement then CBC was done revealed hemoglobin 4mg/dl and high creatinine level. Patient was receiving blood transfusion from being anemic. Today the patient is under investigation to find out renal problem.
25 year old female complaining of 'syncopal 
coma' two times, having butter fly skin rash in the check sparing nasolabial fold , gangreen of big toe and anemia , no other menifestations are seen.
Etiology:
pathogenic autoantibody and immune complex associated with genetic factors and environmental factors .
Symptoms depand on which site are involved e.g
Mucocutanous:@
1. Butter fly skin rash
2. Oral ulcer
3. Photo sensitivity and
4. Alopacia.
Musculoskeletal :
1. Arthralgia
In the lung:
1. Pleurisy and pleural effusion
2. Pleutleitic chest pain
3. Pulmonary hyper tension and
4. Dyspnea .
In the heart:
1. Pericarditis
2. myopathy and endocarditis
In the CNS:
1. Pschycosis
2. Coma
3.severe depression .
In the kidney :
1. kidney failure and
2. Hypertension.
Not all these symptoms are seen in the patient
Management depand on
1. Etiology
2. Symptomps and
3. Investigation.
Medical treatment:
1.NSAIDs in articular and mild symptoms of SLE
2. Antimalarial drug ; hydroxychloroquine in any SLE case.
3. Corticosteroid ; prednisone or prednisolone
Mild dose in mild inflamatry symptomps
Moderate dose in serositis like pericarditis
High dose: in nephritis
Pulse therapy in life threatening conditions
4. Immune suppressive drugs : azathyoprine
Cyclophosphamide ,methotrexate etc. And
5. Biological agents; rituximab and belimumab .
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