Name

Birth Date

Age

Gender

Male Female

Residency

--< Select >-- Cairo Giza Alexandria Port Said Suez Demiatt Dakahlia Sharkia Qalyoubia Kafr Shaikh Gharbia Menouffia Behaira Ismaillia Beni Suif Fayoum Minia Assuit Sohag Qena Asswan Luxor Al Bahr Al Ahmar Al Wadi Al Gaddid Matrouh N. Sinai S. Sinai Other Country

Occupation

Weight (kg)

Height (m)

BMI (Body Mass Index)

Smoking

Yes No

Informed Consent

Malar rash

Yes No

Discoid rash

Yes No

Photosensitivity

Yes No

Alopecia

Yes No

Oral ulcers

Yes No

Fever

Yes No

Arthritis

Yes No

Pleurisy

Yes No

Pleural effusion

Yes No

Pericarditis

Yes No

Lupus nephritis

Yes No

Seizures

Yes No

Psychosis

Yes No

Headache

Yes No

Vasculitis

Yes No

Muscle weakness

Yes No

Anemia

Yes No

Leucopenia

Yes No

Lymphopenia

Yes No

Thromocytopenia

Yes No

ESR (mm/hr)

CRP (mg/dl)

Urine analysis

Proteinuria

Yes No

24 hours urinary protein

Albumin/Creatinine ratio

ANA (Antinuclear antibodies)

Anti-dsDNA

Anti-Smith

C3

C4

Lupus Anticoagulant

Positive Negative Not done

Anticardiolipin Abs

Positive Negative Not done

Anti-B2 Glycoprotein Abs

Positive Negative Not done

Coombs Test

Positive Negative Not done

Anti-Ro

Positive Negative Not done

Anti-La

Positive Negative Not done

Anti-Histone

Positive Negative Not done

Renal biopsy grade

Grade I Grade II Grade III Grade IV Grade V Grade VI

Skin biopsy

MRI Brain

Lumbar Puncture

HRCT Chest

ECHO

Corticosteroids

Yes No

Hydroxychloroquine

Yes No

Azathioprine

Yes No

Mycophenolate Mofetil

Yes No

Cyclophosphamide

Yes No

Cyclosporine

Yes No

Tacrolimus

Yes No

Methotrexate

Yes No

Leflunomide

Yes No

IVIG

Yes No

Rituximab

Yes No