Most commonly, the first definite symptoms are arthritis and other musculoskeletal pain, and rashes often associated with photosensitivity; however, a range of other symptoms including oral ulcerations, Raynaud’s phenomenon, pleuritic chest pain and dry eyes may be seen some time before diagnosis. Changes in the autoantibody profile may take place before more specific organ-related symptoms. identificaThe tion of four of these signs and symptoms (Tan et al, 1982). These include the classic ‘butterfly’ rash across the cheekbones, or a discoid rash.