Diagnosis: The diagnosis is made in the presence of at least 2 appropriate clinical features and strongly positive antinuclear antibody test (ANA) and a positive dsDNA test. The point to note is that ANA should be done by immunofluorescence method and a titre of more than 1: 80 is significant.

Differential diagnosis: Infections are common in our setting and specific infections like tuberculosis should be ruled out. In children, malignancies of the blood and lymph nodes have to be carefully eliminated.

Management:
Patient and parent education: This forms the most vital part of management. It should be made clear that this disorder is chronic and needs careful and continued follow-up. As yet there is no cure but like diabetes or hypertension, good control is possible. Worry regarding the side effects of the medications is inevitable. However, the consequence of untreated disease could be very serious, and hence the need for regular medications. Every effort will be made by the treating physician to control the disease and at the same time minimize the side effects.
   As the skin lesions and at times the disease can worsen with sun exposure, it should be avoided especially when the disease is active.

Medications: For mild to moderate disease, painkillers, chloroquine and small doses of steroid may be sufficient. Those with serious involvement of the kidneys, nervous system, hematological system or cardiovascular system need appropriate aggressive therapy. This often includes high doses of steroids along with drugs like cyclophosphamide.

Regular tests: It is important to realize that since the disease is chronic, regular tests may be needed to monitor both the disease and the drug side effects. Urine examination should be done on monthly basis to detect early renal involvement. CBC & ESR can be done on 2-3 monthly basis.