Diagnose and treat lupus in primary care with tips from rheumatologist, Beth Jonas MD, FACR (UNC). We discuss the history and exam findings in lupus, initial lab workup, the dreaded ANA, who needs expanded lab testing, lifestyle factors in lupus, vaccinations, the basics of treatment...and Jethro Tull?!  Full show notes at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and Produced: Kate Grant MBChB DipGUMed; Matthew Watto MD, FACP Infographic: Matthew Watto MD, FACP Cover Art: Kate Grant MBChB DipGUMed Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD, FACP Guest: Beth Jonas MD, FACR Time Stamps 00:00 Intro, disclaimer, guest bio 03:03 Guest one-liner; Book recommendation*: How Doctors Think (book) by Jerome Groupman; Career advice 10:50 A case of hematuria and rash, Ms Luna Wolferton 12:00 Differential diagnosis for a patient with symptoms suggestive of lupus 13:50 Clues for lupus on history and exam 15:42 Classification criteria versus making a clinical diagnosis of lupus (Dorner 2019) 18:17 ANA, what is it good for? 21:33 Basic lab workup (CBC, urinalysis and TSH) 25:10 Labs to send once lupus is suspected 28:15 Does Ms Wolferton have lupus?  29:10 Spiel for explaining lupus to a patient 31:20 ANA titers 33:02 Are there classic phenotypes of lupus? 34:40 Lifestyle factors 38:20 Bone density and chronic steroids 39:42 Vaccinations; Antimicrobial prophylaxis 41:55 Hydroxychloroquine; Treatment goals in lupus 44:38 Steroids and add on therapies e.g. methotrexate, Belimumab 47:55 The importance of hydroxychloroquine 49:15 Drug-induced lupus (e.g. hydralazine, isoniazid, minocycline, procainamide) 51:17 Take Home Points; Plug: Thurston Arthritis Center at UNC Chapel Hill 53:40 Outro Goals Listeners will recognize and diagnose various presentations of lupus (SLE) in primary care, counsel patients with a new diagnosis of lupus, learn the general approach to treatment, and provide preventive care.  Learning objectives After listening to this episode listeners will... Recognize its myriad manifestations and diagnose lupus.  Perform an initial workup for suspected lupus Interpret positive ANA titers and order appropriate follow up testing Counsel patients with a new diagnosis of lupus Educate patients on nonpharmacologic therapy for lupus Discuss the basics of lupus treatment and monitoring/prevention including vaccinations, control of vascular risk factors, antimicrobial prophylaxis and promotion of bone health Provide excellent primary care and preventive medicine to co-manage lupus Counsel patients with a new diagnosis of lupus  *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures Dr. Jonas reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Citation Jonas B, Williams PN, Watto MF. “#171 Lupus in Primary Care with Beth Jonas MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list September 8, 2019.