Definition
- Multisystem autoimmune disease, most often in women of childbearing age
- ANA positive, anti-dsDNA is specific
- Peak onset 15 to 45 years, with a female to male ratio of about 9 to 1
- Classified with the 2019 EULAR and ACR criteria, which require an ANA of 1 in 80 or more
Musculoskeletal Features
- Non-erosive arthritis
- Jaccoud arthropathy, reducible ulnar deviation and swan neck deformities
- Osteonecrosis, often multifocal and linked to steroid use
- Tendon rupture
- Osteoporosis from disease and steroids
- Arthralgia in up to 90%, often the presenting feature
- Deformities in Jaccoud arthropathy are passively correctable, unlike rheumatoid arthritis
- Myositis and fibromyalgia can overlap
Investigations
- ANA, anti-dsDNA and anti-Smith antibodies
- Low C3 and C4 in active disease
- Full blood count for cytopenias
- Antiphospholipid antibodies before surgery
- MRI for suspected osteonecrosis, which is often bilateral and silent in the hip
Management
- Hydroxychloroquine for all patients unless contraindicated
- Glucocorticoids at the lowest effective dose
- Azathioprine, mycophenolate or belimumab for organ involvement
Perioperative Considerations
- Higher infection risk with immunosuppression
- Antiphospholipid syndrome raises VTE risk
- Thrombocytopenia and bleeding
- Continue hydroxychloroquine
- See Osteonecrosis | Avascular Necrosis
- Assess renal and cardiac involvement before surgery
- Arthroplasty for osteonecrosis in SLE has higher complication rates than for osteoarthritis
- Photosensitivity and skin vasculitis can affect wound care
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.