Background: A 41-year-old, previously healthy woman presented with chest pain, fevers, arthritis, facial rash, pericarditis, proteinuria and a positive antinuclear antibody; she was diagnosed with systemic lupus erythematosus (SLE). She initially responded well to steroids, azathioprine and hydroxychloroquine; however, disease manifestations subsequently worsened in the setting of erratic medical compliance. During this time she participated in an observational study to evaluate risk factors for the development of subclinical atherosclerosis in patients with SLE.
Investigations: Physical examination, laboratory and serologic evaluations, echocardiography, serial carotid artery ultrasonography for detection of atherosclerotic plaque, chest CT, thoracentesis, pleurodesis, and lymphnode biopsy.
Diagnosis: Subclinical carotid atherosclerosis in the setting of active SLE.
Management: Over the course of 7 years the patient received prednisone, azathioprine, hydroxychloroquine, low-dose aspirin, NSAIDs including celecoxib, meloxicam and ibuprofen, mycophenolate mofetil, and methotrexate. Ultimately the patient was prescribed mycophenolate mofetil and prednisone, but she was lost to follow-up.