Oral ulcerations commonly accompany disease flares-the vast majority of patients with sle will experience arthritis. arthritis in the hands, specifically the proximal interphalangeal and metacarpophalangeal joints is symmetrical and nonerosive. thirty percent of patients develop hitchhikers thumb, hyperextension of the ip joint of the thumb. up to 30% of patients have coexisting fibromyalgia. chronic nephritis is seen in approx. 50% of patients. renal biopsy can be useful in making treatment decisions in patients with renal disease. pericarditis is the most common cardiac manifestation of sle, reported in 30% of patients, with an associated effusion in 20% of patients. this rarely progresses to tamponade. the neurologic manifestations of sle are varied (including seizures, stroke, psychosis, migraines, peripheral neuropathies) and may appear early in disease, but are rarely the initial sign of sle. approx 50% of patients with sle will have cns involvement. gi complaints in sle are common and oral ulcerations usually accompany disease flares. other more rare gi complaints include esophageal dysmotility, intestinal pseudo-obstruction, pancreatitis, sbp, portal hypertension, and intestinal vasculitis (the most serious gi complication.) (chapter 116)
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