Doctor:What brings you in today?
Patient:I have joint pain for 4 months. Both hands, both knees. Morning stiffness for about 90 minutes.
Doctor:Any skin changes?
Patient:Yes, a rash on my face — more on both cheeks. It gets worse when I go in the sun. Started 2 months ago.
Doctor:Hair loss?
Patient:Yes, a lot of hair falling — 3 months now. Handfuls when I brush.
Doctor:Mouth ulcers?
Patient:Yes, 2-3 times a month, painful.
Doctor:Any changes in urine?
Patient:It’s been frothy for about a month. I didn’t think it was serious.
Doctor:Swelling anywhere?
Patient:Legs swell in the evening. Face is puffy in the morning.
Doctor:Fever?
Patient:Low grade, 99-100 degrees, 2-3 days a week.
Doctor:Chest pain?
Patient:Left side, when I take a deep breath.
Doctor:Any previous treatment?
Patient:A doctor gave me Prednisolone 10mg. It helped a lot. But when I stopped, everything came back.
Doctor:Family history?
Patient:My mother has some thyroid problem, she takes Thyronorm 50. My sister is getting treatment for joint pains in Chennai.
Doctor:High fever? Breathlessness? Previous BP issues?
Patient:No, no, and no.
Physician examination notes
BP: 148/96 (repeated: 146/94). B/L pedal edema. Periorbital puffiness. Malar rash — bilateral malar distribution. No lymphadenopathy. Chest: clear bilateral. Abdomen: soft, no organomegaly.