systemic lupus erythematosus
Enable an AI agent to recognise a documented systemic lupus erythematosus presentation, assess its evolving activity and consequences, and support clinician-directed monitoring and care decisions.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
recalled by Codex without web access - no source was read
Researched by: Codex
Purpose and description
Enable an AI agent to recognise a documented systemic lupus erythematosus presentation, assess its evolving activity and consequences, and support clinician-directed monitoring and care decisions.
Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by loss of tolerance to self-antigens, autoantibody production, and variable inflammatory injury affecting multiple organs, often with a relapsing-remitting course.
It can be Assemble a dated diagnostic evidence summary with conflicting findings and missing investigations.; Compare successive assessments to flag possible flare, organ involvement or treatment complications for clinical review.; Track clinician-selected activity and damage measures without silently substituting one instrument for another.; Construct a monitoring checklist tied to documented manifestations, therapies and the applicable guideline version.; Summarise treatment response, patient priorities and unresolved trade-offs for shared decisions.; Route concerning changes through an established escalation pathway while preserving diagnostic uncertainty..
Distinguishing features
Require a coherent clinical history, examination and supporting investigations; a positive antinuclear antibody result alone does not establish SLE. [NIAMS diagnosis](https://www.niams.nih.gov/health-topics/lupus/diagnosis-treatment-and-steps-to-take)
Distinguish SLE from isolated cutaneous lupus by recording the full clinical and immunological assessment; a skin lesion alone does not determine the systemic diagnosis.
Examine medication exposure, symptom chronology and clinician attribution when distinguishing SLE from drug-induced lupus.
Distinguish a suspected lupus flare from infection, treatment toxicity and established damage by retaining competing explanations for each new abnormality.
Record antiphospholipid antibodies and thrombotic or obstetric events separately from the SLE diagnosis, allowing an independently assessed antiphospholipid syndrome relationship.
Scope
+ Evidence supporting or challenging an SLE diagnosis and its distinction from research classification
+ Organ-specific manifestations and the evidence attributing them to SLE
+ Disease activity, flares, remission, accumulated damage and patient-experienced burden
+ Autoantibody, complement, blood, urine and tissue findings interpreted in clinical context
+ Treatment objectives, observed response, adverse effects and monitoring dependencies
+ SLE-specific reproductive, thrombotic, infection and cardiovascular risk interfaces
- Independent models of isolated cutaneous lupus, drug-induced lupus and neonatal lupus
- Full definitions and management of antiphospholipid syndrome or other overlapping autoimmune diseases
- Complete nephrology models of kidney pathology, chronic kidney disease and renal replacement therapy
- Drug manufacture, pharmacology and prescribing protocols as independent subjects
- General pregnancy management and comprehensive models of infection or cardiovascular disease
Characteristics
- Diagnostic standing
- Suspected, clinician-established, under reassessment or excluded; assessor and date required Prevents a screening result or provisional label from becoming an unquestioned diagnosis.
- Classification assessment
- Named criteria set and version; met, not met or insufficient information Keeps research classification distinct from clinical diagnostic judgment.
- Manifestation attribution
- Manifestation linked to SLE, another cause, multiple causes or unresolved attribution, with evidence A new symptom in someone with SLE need not be caused by SLE.
- Organ involvement
- Mucocutaneous, musculoskeletal, renal, hematologic, neuropsychiatric, cardiopulmonary or other specified involvement The affected organ and severity determine the care pathway.
- Autoantibody profile
- Antibody specificity, result, assay, laboratory reference range and collection date; ANA titre and pattern where reported Makes supporting evidence comparable without treating different assays as interchangeable.
- Complement profile
- C3 and C4 in laboratory-reported units with reference intervals and longitudinal trend Preserves a potentially relevant activity signal without equating it with clinical activity.
- Renal surveillance
- Creatinine, eGFR, urine protein quantification and urine sediment, each with units, method and date Supports detection and follow-up of possible renal involvement.
- Disease activity
- Named instrument such as SLEDAI-2K or BILAG-2004, version, score or grades, assessment window and missing items Allows longitudinal assessment while preserving the meaning and limits of the instrument used.
- Clinical course
- Active, improving, stable, suspected flare, defined low disease activity or defined remission Records change over time and requires explicit definitions for treatment targets.
- Accumulated damage
- Named damage instrument and item-level findings, onset, persistence and attributed causes Separates persistent consequences from potentially reversible inflammation.
- Treatment exposure
- Therapy linked to indication, dose, dates, actual use, response and adverse events Makes response and toxicity interpretable against what the person actually received.
- Patient-experienced burden
- Fatigue, pain, function and quality-of-life measures with instrument, scale and date Captures consequences that clinician-assessed inflammatory activity may not explain.
Also called
Where this came from
wikidata · CC0 1.0
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 7 bundles · 13 layers · 21 findings · 33 questions.
SLE identity and diagnostic evidence Establish what supports this SLE label and how competing explanations were evaluated.
An agent must distinguish an established diagnosis from seropositivity, a classification result or an unresolved lupus-like presentation.
Clinical diagnosis and classification
Maintain separate records of clinical judgment and criteria-based classification.
Diagnostic basis
Record the diagnosing clinician, chronology, supporting manifestations, investigations and any separately applied classification framework.
- Who established or questioned the SLE diagnosis, when, and on what clinical evidence? provenance
- Which classification framework, if any, was applied, and which observations supported or failed its requirements? definition
Lupus boundaries and mimics
Record alternatives including isolated cutaneous lupus, drug-induced lupus and overlapping connective tissue disease.
Alternative explanations
Represent each competing diagnosis with supporting evidence, contradictory evidence and unresolved distinctions.
- What evidence distinguishes this presentation from isolated cutaneous lupus, drug-induced lupus or another connective tissue disease? boundary
- Which medication exposures, infection findings or other conditions could explain the apparent lupus manifestations? provenance
Immune and laboratory context Interpret immunological evidence and laboratory trends in relation to clinical observations.
Lupus assessment uses multiple tests whose meaning depends on assay, timing and accompanying manifestations.
Autoantibody evidence
Preserve antibody specificity and analytical context.
Serological profile
Record ANA, anti-dsDNA, anti-Sm and other relevant antibodies without treating an individual result as a complete diagnosis.
- Which antibodies were measured, using which methods, and what were the results and laboratory reference limits? measurement
- Which results support the clinician's SLE assessment, and which instead inform an overlap diagnosis or a specific risk? boundary
Laboratory and clinical concordance
Compare serial laboratory changes with symptoms, examination and treatment exposure.
Discordant activity signals
Retain disagreement between serological trends and clinical activity as an unresolved assessment issue.
- How have complement, anti-dsDNA and blood counts changed relative to the person's baseline and clinical course? measurement
- When laboratory and clinical findings disagree, what explanation and follow-up plan has the clinician documented? action
Organ involvement and attribution Describe where SLE may be active and how confidently manifestations are attributed to it.
A global lupus label cannot convey the significance of renal changes, inflammatory joint symptoms or potentially urgent organ dysfunction.
Renal involvement
Track evidence of possible lupus nephritis and link to specialist renal assessment.
Renal evidence and pathology
Connect urine findings, kidney function and any biopsy interpretation while preserving alternative renal causes.
- What do serial urine protein measurements, urine sediment and kidney function show, and over what interval? measurement
- If a kidney biopsy was performed, what did the report establish about classification, activity, chronicity and competing pathology? provenance
Extrarenal manifestations
Record attributed skin, joint, blood, nervous system, heart and lung findings individually.
Manifestation severity and cause
For each manifestation, retain onset, objective evidence, functional effect, severity and possible non-lupus causes.
- Which extrarenal findings are present, how severe are they, and what evidence attributes each to SLE? measurement
- Which findings require prompt clinical assessment under the applicable pathway, and who owns that escalation? action
Activity, damage and lived course Separate current inflammation, persistent consequences and the person's experienced burden.
These dimensions can diverge and support different interpretations of whether care is succeeding.
Activity and treatment targets
Record disease trajectory using explicit assessment windows and target definitions.
Flare and target assessment
Document the evidence for a flare and the exact framework used to describe remission or low disease activity.
- Which new or worsening findings support a flare compared with the previous assessment, and what alternatives remain? boundary
- What definition, instrument and observation window support the recorded activity state or treatment target? definition
Damage and patient burden
Keep persistent organ consequences and patient-reported outcomes visible alongside activity scores.
Persistent consequences
Record damage and limitations without assuming that every persistent symptom represents active lupus.
- Which persistent changes meet the selected damage definition, and are they attributed to SLE, treatment or another cause? boundary
- How are fatigue, pain and daily function changing, and where do they diverge from assessed inflammatory activity? measurement
Therapy, response and monitoring Link treatment decisions to manifestations, measurable goals, actual exposure and safety monitoring.
An agent needs enough context to support a documented care plan and identify gaps without deriving prescriptions from a disease label.
Treatment purpose and response
Represent the rationale and observed results of each therapy within a versioned clinical plan.
Manifestation-linked treatment
Record the target manifestation, intended outcome, review interval and clinician-approved plan; relevant guidance includes the [2025 ACR SLE guideline](https://doi.org/10.1002/acr.25690).
- Which manifestations and patient priorities does each therapy address, and how will benefit be assessed? action
- What treatment was actually taken, and how did clinical findings change after initiation, adjustment or interruption? provenance
Exposure and toxicity
Track lupus treatment exposure together with medication-specific monitoring requirements.
Treatment monitoring dependencies
Capture glucocorticoid exposure, hydroxychloroquine eye-monitoring arrangements where applicable, and relevant surveillance for other therapies.
- What cumulative exposure, suspected toxicity or monitoring gap could affect the documented treatment plan? measurement
- Which monitoring or medication-review actions are due, according to the responsible clinician's plan and cited guidance? action
Reproductive and comorbidity interfaces Connect SLE to risk assessments that require coordinated care across neighbouring models.
Pregnancy, thrombosis, infection and cardiovascular disease introduce decisions that disease activity alone cannot resolve.
Reproductive and antibody context
Record reproductive intentions and relevant clinical and antibody findings without inferring pregnancy or reproductive capacity.
Pregnancy and thrombosis links
Link pregnancy planning or pregnancy to disease state, medication review and relevant antibody findings; preserve separate assessment of antiphospholipid syndrome. [NIAMS pregnancy considerations](https://www.niams.nih.gov/health-topics/lupus/diagnosis-treatment-and-steps-to-take)
- If reproductive care is relevant, what disease activity, renal history, antibody results and medication exposures must the care team review? action
- Are antiphospholipid antibodies, thrombotic events or obstetric complications documented, and has antiphospholipid syndrome been independently assessed? boundary
Infection and cardiovascular context
Connect intercurrent illness and preventive care to SLE activity and treatment exposure.
Competing risks and prevention
Preserve infection as a competing explanation for deterioration and record coordinated preventive care responsibilities.
- For a new deterioration, what evidence supports infection, lupus activity, treatment toxicity or more than one cause? boundary
- What infection-prevention and cardiovascular-risk actions are documented, and who is responsible for follow-up? action
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Check these first
Recalled without web access and unsourced; every item is a lead to verify.
- This description is recalled knowledge; no sources were consulted.
- Age thresholds for childhood-onset and late-onset SLE vary between studies, and these are descriptive groupings rather than universally standardized subtypes.
- Verify current guideline versions and local coding details; no single laboratory result establishes or excludes SLE.
- Which of these check these first hold for the sense of systemic lupus erythematosus this model covers, and on what evidence? provenance
Kinds and varieties
Recalled without web access and unsourced; every item is a lead to verify.
- Childhood-onset SLE
- Adult-onset SLE
- Late-onset SLE
- Which of these kinds and varieties hold for the sense of systemic lupus erythematosus this model covers, and on what evidence? provenance
Identifiers and schemes
Recalled without web access and unsourced; every item is a lead to verify.
- ICD-10, World Health Organization - M32 - Systemic lupus erythematosus category; subcodes distinguish forms and involvement, with national coding modifications.
- Which of these identifiers and schemes hold for the sense of systemic lupus erythematosus this model covers, and on what evidence? provenance
Standards and regulation
Recalled without web access and unsourced; every item is a lead to verify.
- 2019 EULAR/ACR classification criteria, issued by the European Alliance of Associations for Rheumatology and American College of Rheumatology; classification criteria support research cohort definition and are not diagnostic rules.
- 2012 SLICC classification criteria, developed by the Systemic Lupus International Collaborating Clinics.
- 2023 EULAR recommendations for the management of systemic lupus erythematosus.
- KDIGO 2024 Clinical Practice Guideline for the Management of Lupus Nephritis.
- Which of these standards and regulation hold for the sense of systemic lupus erythematosus this model covers, and on what evidence? provenance
Real-world use
Recalled without web access and unsourced; every item is a lead to verify.
- Clinical recognition and longitudinal management of multisystem autoimmune disease.
- Classification of participants for clinical trials and observational research.
- Monitoring disease activity, accumulated organ damage, and treatment response.
- Assessment of pregnancy-related risks and coordination of specialist care.
- Health surveillance and administrative coding.
- Which of these real-world use hold for the sense of systemic lupus erythematosus this model covers, and on what evidence? provenance
Typical measurements
Recalled without web access and unsourced; every item is a lead to verify.
- Disease activity assessed using SLEDAI-2K - Possible score 0-105; this is the instrument range, not a typical patient range. - score points
- Serum complement C3 and C4 concentrations - Laboratory-dependent; reduced concentrations may accompany active disease. - g/L or mg/dL
- Urinary protein excretion - Variable; increased excretion can indicate renal involvement and requires contextual interpretation. - g/24 h
- Which of these typical measurements hold for the sense of systemic lupus erythematosus this model covers, and on what evidence? provenance
Failure modes and hazards
Recalled without web access and unsourced; every item is a lead to verify.
- Lupus nephritis can cause irreversible kidney damage and kidney failure.
- Neurological, cardiac, pulmonary, and hematological involvement can be organ-threatening or life-threatening.
- Infection can mimic a flare and can be worsened by immunosuppressive treatment.
- Accelerated cardiovascular disease and thrombosis, particularly with associated antiphospholipid syndrome, contribute to morbidity.
- Misinterpreting isolated autoantibody positivity or research classification criteria as sufficient for diagnosis can cause misdiagnosis.
- Which of these failure modes and hazards hold for the sense of systemic lupus erythematosus this model covers, and on what evidence? provenance
Regional variation
Recalled without web access and unsourced; every item is a lead to verify.
- Reported prevalence, severity, and organ involvement vary across populations; ancestry, environment, ascertainment, and access to care all contribute.
- Access to rheumatology, laboratory monitoring, kidney biopsy, and treatment affects recognition and outcomes.
- ICD subcodes and treatment availability differ across national health systems.
- Which of these regional variation hold for the sense of systemic lupus erythematosus this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Recalled without web access and unsourced; every item is a lead to verify.
- Cutaneous lupus erythematosus - Primarily denotes lupus affecting the skin; it may occur independently or as part of SLE, so skin lesions alone do not establish systemic disease.
- Drug-induced lupus - A lupus-like syndrome associated with a causative medication, typically improving after withdrawal; clinical and antibody patterns depend on the drug.
- Lupus nephritis - Renal involvement associated with SLE, rather than a synonym for the entire systemic disease.
- Antiphospholipid syndrome - Defined around characteristic thrombotic or obstetric manifestations and persistent antiphospholipid antibodies; it can occur independently or alongside SLE.
- Neonatal lupus - Results from transferred maternal autoantibodies and is not equivalent to childhood-onset SLE.
- Which of these neighbouring kinds and how to tell them apart hold for the sense of systemic lupus erythematosus this model covers, and on what evidence? provenance
What the second pass must settle
- Which diagnostic and classification frameworks should the completed model support across adult, childhood-onset and incomplete lupus presentations?
- Which activity, remission, low disease activity and damage definitions should be adopted, and how should assessments using different instruments remain comparable?
- What evidence should be required to attribute neuropsychiatric symptoms, fatigue or persistent pain to SLE when competing explanations remain plausible?
- Which assay-specific trends and combinations of observations justify a review alert, particularly when serological activity and clinical findings disagree?
- How should the completed model divide responsibility with lupus nephritis, antiphospholipid syndrome and reproductive-care models while retaining a coherent SLE assessment?