Systemic lupus erythematosus Quiz: Ace Your Exams

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A 27-year-old woman comes to the clinic due to pain in her hands as well as fatigue for the past three weeks. The patient has also noticed that her urine appears darker than normal. Medical history is non-contributory, and the patient takes no medication. The patient’s temperature is 37.6 C (99.6 F), pulse is 75/min, respirations are 14/min, and blood pressure is 142/87 mmHg. Physical examination shows erythema and swelling of multiple metacarpophalangeal and proximal interphalangeal joints bilaterally, with tenderness on palpation. Physical examination of her neck and chest is shown below:  


Reproduced from: U.S. National Library of Medicine
 *Dark red spots are biopsy sites  

Laboratory findings are positive for antinuclear antibodies (ANA). Further evaluation of this patient is most likely to show which of the following?

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