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Systemic Lupus Erythematosus N029

Document
Last amended 
17 March 2016
Current RMA Instruments:
Reasonable Hypothesis SOP
21 of 2016
Balance of Probabilities SOP
22 of 2016
Changes from previous Instruments:

SOP Bulletin 188

ICD Coding:
  • ICD-9-CM Codes: 710.0
  • ICD-10-AM Codes: M32, L93.1, L93.2
Brief description

Systemic lupus erythematosus (SLE) is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain, and other organs.

Confirming the diagnosis

SLE has a variable presentation and there are no definitve diagnostic tests.  The diagnosis is generally based on clinical judgment, after extensive specialist evaluation and laboratory tests and the exclusion of alternative diagnoses. 

The relevant medical specialist is a rheumatologist.  A range of other specialists may be involved in treatment for the condition.

Additional diagnoses that are covered by SOP
  • Nil
Conditions that may be covered by SOP (see comments)
  • Cutaneous lupus erythematosus
Conditions not covered by SOP
  • Discoid lupus erythematosus*
  • Mixed connective tissue disease#

* another SOP applies

# non-SOP condition

Comments

There are a number of forms of cutaneous lupus erythematosus.  Discoid lupus is the most common form and has its own SOP.  Cutaneous lupus in isolation is not covered by the SLE SOP and if not the discoid form, is a non-SOP condition. Acute, sub-acute and chronic forms of cutaneous lupus may occur as part of the wider disease of SLE.

Clinical onset

Diagnosis of SLE can be difficult and may involve a lengthy process.  Once the diagnosis has been confirmed it may be possible to back-date the clinical onset to time well before diagnosis based on the onset of relevant symptoms.

Clinical worsening

Systemic lupus erythematosus (SLE) can run a varied clinical course, ranging from a relatively benign illness to a rapidly progressive disease with fulminant organ failure and death.  The condition has a remitting and relapsing course in some patients.  Establishing clinical worsening beyond the normal course of the disease is likely to be difficult and require specialist opinion.