Diagnosing and Treating Lupus



Diagnosis

Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may change over time and overlap with those of many other disorders.

No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis.

Laboratory tests

Blood and urine tests may include:

  • Complete blood count. This test measures the number of red blood cells, white blood cells and platelets as well as the amount of hemoglobin, a protein in red blood cells. Results may indicate you have anemia, which commonly occurs in lupus. A low white blood cell or platelet count may occur in lupus as well.
  • Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate isn’t specific for any one disease. It may be elevated if you have lupus, an infection, another inflammatory condition or cancer.
  • Kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs.
  • Urinalysis. An examination of a sample of your urine may show an increased protein level or red blood cells in the urine, which may occur if lupus has affected your kidneys.
  • Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies — produced by your immune system — indicates a stimulated immune system. While most people with lupus have a positive ANA test, most people with a positive ANA do not have lupus. If you test positive for ANA, your doctor may advise more-specific antibody testing.

Imaging tests

If your doctor suspects that lupus is affecting your lungs or heart, he or she may suggest:

  • Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or inflammation in your lungs.
  • Echocardiogram. This test uses sound waves to produce real-time images of your beating heart. It can check for problems with your valves and other portions of your heart.

Biopsy

Lupus can harm your kidneys in many different ways, and treatments can vary, depending on the type of damage that occurs. In some cases, it’s necessary to test a small sample of kidney tissue to determine what the best treatment might be. The sample can be obtained with a needle or through a small incision.

Skin biopsy is sometimes performed to confirm a diagnosis of lupus affecting the skin.

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Treatment

Treatment for lupus depends on your signs and symptoms. Determining whether you should be treated and what medications to use requires a careful discussion of the benefits and risks with your doctor.

As your signs and symptoms flare and subside, you and your doctor may find that you’ll need to change medications or dosages. The medications most commonly used to control lupus include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), may be used to treat pain, swelling and fever associated with lupus. Stronger NSAIDs are available by prescription. Side effects of NSAIDs may include stomach bleeding, kidney problems and an increased risk of heart problems.
  • Antimalarial drugs. Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), affect the immune system and can help decrease the risk of lupus flares. Side effects can include stomach upset and, very rarely, damage to the retina of the eye. Regular eye exams are recommended when taking these medications.
  • Corticosteroids. Prednisone and other types of corticosteroids can counter the inflammation of lupus. High doses of steroids such as methylprednisolone (Medrol) are often used to control serious disease that involves the kidneys and brain. Side effects include weight gain, easy bruising, thinning bones, high blood pressure, diabetes and increased risk of infection. The risk of side effects increases with higher doses and longer term therapy.
  • Immunosuppressants. Drugs that suppress the immune system may be helpful in serious cases of lupus. Examples include azathioprine (Imuran, Azasan), mycophenolate (Cellcept), methotrexate (Trexall, Xatmep, others), cyclosporine (Sandimmune, Neoral, Gengraf) and leflunomide (Arava). Potential side effects may include an increased risk of infection, liver damage, decreased fertility and an increased risk of cancer.
  • Biologics. A different type of medication, belimumab (Benlysta) administered intravenously, also reduces lupus symptoms in some people. Side effects include nausea, diarrhea and infections. Rarely, worsening of depression can occur.

    Rituximab (Rituxan, Truxima) may be beneficial for some people in whom other medications haven’t helped. Side effects include allergic reaction to the intravenous infusion and infections.

In clinical trials, voclosporin has been shown to be effective in treating lupus.

Other potential drugs to treat lupus are currently being studied, including abatacept (Orencia), anifrolumab and others.

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Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Products and Services

If you receive care for lupus at Mayo Clinic, consider registering for this online class: Living Well with Lupus.

Diagnosis and treatment

Take steps to care for your body if you have lupus. Simple measures can help you prevent lupus flares and, should they occur, better cope with the signs and symptoms you experience. Try to:

  • See your doctor regularly. Having regular checkups instead of only seeing your doctor when your symptoms worsen may help your doctor prevent flares, and can be useful in addressing routine health concerns, such as stress, diet and exercise that can be helpful in preventing lupus complications.
  • Be sun smart. Because ultraviolet light can trigger a flare, wear protective clothing — such as a hat, long-sleeved shirt and long pants — and use sunscreen with a sun protection factor (SPF) of at least 55 every time you go outside.
  • Get regular exercise. Exercise can help keep your bones strong, reduce your risk of heart attack and promote general well-being.
  • Don’t smoke. Smoking increases your risk of cardiovascular disease and can worsen the effects of lupus on your heart and blood vessels.
  • Eat a healthy diet. A healthy diet emphasizes fruits, vegetables and whole grains. Sometimes you may have dietary restrictions, especially if you have high blood pressure, kidney damage or gastrointestinal problems.
  • Ask your doctor if you need vitamin D and calcium supplements. There is some evidence to suggest that people with lupus may benefit from supplemental vitamin D. A calcium supplement can help you meet the daily recommended dietary allowance of 1,000 milligrams to 1,200 milligrams — depending on your age — to help keep your bones healthy.

Alternative medicine

Sometimes people with lupus seek alternative or complementary medicine. There aren’t any alternative therapies that have been shown to alter the course of lupus, although some may help ease symptoms of the disease.

Discuss these treatments with your doctor before initiating them on your own. He or she can help you weigh the benefits and risks and tell you if the treatments will interfere adversely with your current lupus medications.

Complementary and alternative treatments for lupus include:

  • Dehydroepiandrosterone (DHEA). Taking supplements containing this hormone along with conventional treatment may help reduce lupus flares. DHEA may lead to acne in women.
  • Fish oil. Fish oil supplements contain omega-3 fatty acids that may be beneficial for people with lupus. Preliminary studies have found some promise, though more study is needed. Side effects of fish oil supplements can include nausea, belching and a fishy taste in the mouth.
  • Acupuncture. This therapy uses tiny needles inserted just under the skin. It may help ease the muscle pain associated with lupus.

Coping and support

If you have lupus, you’re likely to have a range of painful feelings about your condition, from fear to extreme frustration. The challenges of living with lupus increase your risk of depression and related mental health problems, such as anxiety, stress and low self-esteem. To help you cope, try to:

  • Learn all you can about lupus. Write down any questions you have about lupus as they occur to you so that you can ask them at your next appointment. Ask your doctor or nurse for reputable sources of further information. The more you know about lupus, the more confident you’ll feel in your treatment choices.
  • Gather support among your friends and family. Talk about lupus with your friends and family and explain ways they can help out when you’re having flares. Lupus can be frustrating for your loved ones because they usually can’t see it, and you may not appear sick.

    Family and friends can’t tell if you’re having a good day or a bad day unless you tell them. Be open about what you’re feeling so that your loved ones know what to expect.

  • Take time for yourself. Cope with stress in your life by taking time for yourself. Use that time to read, meditate, listen to music or write in a journal. Find activities that calm and renew you.
  • Connect with others who have lupus. Talk to other people who have lupus. You can connect through support groups in your community or through online message boards. Other people with lupus can offer unique support because they’re facing many of the same obstacles and frustrations that you’re facing.

Preparing for your appointment

You’re likely to start by seeing your primary care doctor, but he or she may refer you to a specialist in the diagnosis and treatment of inflammatory joint conditions and immune disorders (rheumatologist).

Because the symptoms of lupus can mimic so many other health problems, you may need patience while waiting for a diagnosis. Your doctor must rule out a number of other illnesses before diagnosing lupus. You may need to see a number of specialists such as doctors who treat kidney problems (nephrologists), blood disorders (hematologists) or nervous system disorders (neurologists) depending on your symptoms, to help with diagnosis and treatment.

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

  • When did your symptoms begin? Do they come and go?
  • Does anything seem to trigger your symptoms?
  • Have your parents or siblings had lupus or other autoimmune disorders?
  • What medications and supplements do you take regularly?

You may also want to write down questions to ask your doctor, such as:

  • What are the possible causes of my symptoms or condition?
  • What tests do you recommend?
  • If these tests don’t pinpoint the cause of my symptoms, what additional tests might I need?
  • Are there any treatments or lifestyle changes that might help my symptoms now?
  • Do I need to follow any restrictions while we’re seeking a diagnosis?
  • Should I see a specialist?
  • If you are considering pregnancy, be sure to discuss this with your doctor. Some medications cannot be used if you get pregnant.

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions during your appointment at any time that you don’t understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over any points you want to spend more time on. Your doctor may ask:

  • Does sun exposure cause you to develop skin rashes?
  • Do your fingers become pale, numb or uncomfortable in the cold?
  • Do your symptoms include any problems with memory or concentration?
  • How much do your symptoms limit your ability to function at school, at work or in personal relationships?
  • Have you been diagnosed with any other medical conditions?
  • Are you pregnant, or do you plan to become pregnant?

Jan. 27, 2021

FAQs

How early can you detect lupus?

Most people with lupus receive a diagnosis between the ages of 15 and 44. Only around 15 percent of people experience symptoms of lupus before the age of 18. Demographic and other factors can affect the severity and progression of the condition.

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How can you be checked for lupus?

Your doctor will look for rashes and other signs that something is wrong. Blood and urine tests. The antinuclear antibody (ANA) test can show if your immune system is more likely to make the autoantibodies of lupus. Most people with lupus test positive for ANA.

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Can a blood test detect lupus?

Articles On Lupus And unlike other diseases, doctors can’t diagnose it with a single lab test. But your doctor can look at your symptoms and family history and then use lab tests to confirm a diagnosis of lupus. Blood tests and other tests can also help monitor the disease and show the effects of treatment

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Does early lupus show up in blood work?

98% of all people with systemic lupus have a positive ANA test, making it the most sensitive diagnostic test for confirming diagnosis of the disease. The test for anti-nuclear antibodies is called the immunofluorescent antinuclear antibody test. In this test, a blood sample is drawn and sent to a laboratory.

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How long can lupus go undiagnosed?

Lupus symptoms can also be unclear, can come and go, and can change. On average, it takes nearly six years for people with lupus to be diagnosed, from the time they first notice their lupus symptoms. A majority (63%) of people with lupus surveyed report being incorrectly diagnosed.

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What is borderline lupus?

Borderline lupus, which can also be known as unspecified connective tissue disease, or probable lupus, or latent lupus, would define a patient who may have a positive ANA without a DNA or Smith antibody (blood tests used to diagnose lupus), who has arthralgias rather than arthritis, a brain fog or memory loss, and no …

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How long can you have lupus without knowing?

Lupus symptoms can also be unclear, can come and go, and can change. On average, it takes nearly six years for people with lupus to be diagnosed, from the time they first notice their lupus symptoms.

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What does a lupus flare feel like?

During a lupus flare, you could expect to have rashes, joint pain, and possibly a new symptom, too. Some common symptoms of lupus flares include: Painful and swollen joints. Rashes.

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What does early lupus feel like?

Painful, swollen joints

Inflammation can cause pain, stiffness, and visible swelling in your joints, particularly in the morning. It may be mild at first and gradually become more obvious. Like other symptoms of lupus, joint problems can come and go.

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What happens if lupus goes undiagnosed?

If left untreated, it can put you at risk of developing life-threatening problems such as a heart attack or stroke. In many cases, lupus nephritis does not cause any noticeable symptoms. However, this does not mean the condition is not dangerous, as the kidneys could still be being damaged.

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Lupus – Diagnosis and treatment – Mayo Clinic

Lupus – Diagnosis and treatment DiagnosisDiagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may change over time and overlap with those of many other disorders. No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis. Laboratory testsBlood and urine tests may include: Complete blood count. This test measures the number of red blood cells, white blood cells and platelets as well as the amount of hemoglobin, a protein in red blood cells. Results may indicate you have anemia, which commonly occurs in lupus. A low white blood cell or platelet count may occur in lupus as well. Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate isn’t specific for any one disease. It may be elevated if you have lupus, an infection, another inflammatory condition or cancer. Kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs. Urinalysis. An examination of a sample of your urine may show an increased protein level or red blood cells in the urine, which may occur if lupus has affected your kidneys. Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies — produced by your immune system — indicates a stimulated immune system. While most people with lupus have a positive ANA test, most people with a positive ANA do not have lupus. If you test positive for ANA, your doctor may advise more-specific antibody testing. Imaging testsIf your doctor suspects that lupus is affecting your lungs or heart, he or she may suggest: Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or inflammation in your lungs. Echocardiogram. This test uses sound waves to produce real-time images of your beating heart. It can check for problems with your valves and other portions of your heart. BiopsyLupus can harm your kidneys in many different ways, and treatments can vary, depending on the type of damage that occurs. In some cases, it’s necessary to test a small sample of kidney tissue to determine what the best treatment might be. The sample can be obtained with a needle or through a small incision. Skin biopsy is sometimes performed to confirm a diagnosis of lupus affecting the skin.More Information TreatmentTreatment for lupus depends on your signs and symptoms. Determining whether you should be treated and what medications to use requires a careful discussion of the benefits and risks with your doctor. As your signs and symptoms flare and subside, you and your doctor may find that you’ll need to change medications or dosages. The medications most commonly used to control lupus include: Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), may be used to treat pain, swelling and fever associated with lupus. Stronger NSAIDs are available by prescription. Side effects of NSAIDs may include stomach bleeding, kidney problems and an increased risk of heart problems. Antimalarial drugs. Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil), affect the immune system and can help decrease the risk of lupus flares. Side effects can include stomach upset and, very rarely, damage to the retina of the eye. Regular eye exams are recommended when taking these medications. Corticosteroids. Prednisone and other types of corticosteroids can counter the inflammation of lupus. High doses of steroids such as methylprednisolone (Medrol) are often…

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Diagnosing and Treating Lupus – CDC

Diagnosing and Treating LupusTalk to your doctor if you have lupus symptoms. Lupus is a chronic disease with no cure. This means that you can manage it with treatment, but it will not go away. Treatment can help improve your symptoms, prevent flares, and prevent other health problems often caused by lupus. Your treatment will depend on your symptoms and needs. How is lupus diagnosed? Lupus can be hard to diagnose because it has many symptoms that are often mistaken for symptoms of other diseases. Many people have lupus for a while before they find out they have it. If you have symptoms of lupus, tell your doctor right away. No single test can tell if a person has lupus. But your doctor can find out if you have lupus in other ways, including: Medical history. Tell your doctor about your symptoms and other problems. Keep track of your symptoms by writing them down when they happen. Also, track how long they last. Family history of lupus or other autoimmune diseases. Tell your doctor if lupus or other autoimmune diseases run in your family. Complete physical exam. Your doctor will look for rashes and other signs that something is wrong. Blood and urine tests. The antinuclear antibody (ANA) test can show if your immune system is more likely to make the autoantibodies of lupus. Most people with lupus test positive for ANA. But, a positive ANA does not always mean you have lupus. If you test positive for ANA, your doctor will likely order more tests for antibodies that are specific to systemic lupus erythematosus (SLE). Skin or kidney biopsy. A biopsy is a minor surgery to remove a sample of tissue. The tissue is then viewed under a microscope. Skin and kidney tissue looked at in this way can show signs of an autoimmune disease. Your doctor may use any or all of these tests to make your diagnosis. They also can help your doctor rule out other diseases that can be confused with lupus. How is lupus treated? There is no cure for lupus but treatments can help you feel better and improve your symptoms. Your treatment will depend on your symptoms and needs. The goals of treatment are to: Prevent flares Treat symptoms when they happen Reduce organ damage and other problems Your treatment might include medicines to: Reduce swelling and pain Calm your immune system to prevent it from attacking the organs and tissues in your body Reduce or prevent damage to the joints Reduce or prevent organ damage What types of medicines treat lupus? Several different types of medicines treat lupus. Your doctors and nurses may change the medicine they prescribe for your lupus as your symptoms and needs change. Types of medicines commonly used to treat lupus include: Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as ibuprofen and naproxen, help reduce mild pain and swelling in joints and muscles. Corticosteroids. Corticosteroids (prednisone) may help reduce swelling, tenderness, and pain. In high doses, they can calm the immune system. Corticosteroids, sometimes just called “steroids,” come in different forms: pills, a shot, or a cream to apply to the skin. Lupus symptoms usually respond very quickly to these powerful drugs. Once this has happened, your doctor will lower your dose slowly until you no longer need it. The longer a person uses these drugs, the harder it becomes to lower the dose. Stopping this medicine suddenly can harm your body. Talk to your doctor: About any side effects you may have If your medicines no longer help your symptoms If you have new symptoms If you want to become pregnant About any vitamins or herbal supplements you take — they might not mix well with medicines you use to treat lupus Can I treat my lupus with alternative medicine? Some people with lupus try creams, ointments, fish oil, or supplements they can buy without a prescription. Some people try homeopathy or see a chiropractor to care for their lupus. Some…

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Diagnosing lupus – Lupus Foundation of America

Diagnosing lupusDiagnosing lupus can be challenging. There’s no single test that can give doctors a “yes” or “no” answer. Sometimes it can take months—or even years—to gather all the right information.Making a lupus diagnosis is kind of like putting together a puzzle. Your doctor will look at several different puzzle pieces: your symptoms, medical history, family history, and lab tests. If enough of the pieces fit together, you may be diagnosed with lupus.What questions will my doctor ask?If your doctor thinks you might have lupus, they’ll ask you questions about your symptoms, like:What symptoms are you having?How often do you have these symptoms?When did your symptoms start?Does anything make your symptoms better or worse?Are your symptoms constant or do they come and go?Do your symptoms get worse at a certain time of day?Do your symptoms get in the way of your daily routine?Your doctor may also ask if anyone in your family has had lupus or another autoimmune disease (a disease where the immune system attacks healthy tissue). That’s because people who have a family member with an autoimmune disease may be more likely to develop lupus.Get ready for your appointmentBefore your doctor’s appointment, take a few minutes to think through the questions above. Try writing down your answers and taking them with you to the doctor’s office.You can also use these resources to get ready for your appointment:Learn more about the signs and symptoms of lupusTake a few minutes to fill in this symptom checklistFollow these 6 tips to make the most of your appointmentWhat types of tests can help diagnose lupus?Your doctor might give you different lab tests to figure out if you have lupus. While no single test can diagnose lupus, tests help doctors check for changes in your body — like inflammation — that could be caused by lupus. Blood testsBlood tests can help doctors see things like how your immune system is working, or if there are signs of inflammation in your body. Your doctor may ask you to get these blood tests:A complete blood count (CBC) to measure the numbers of red blood cells, white blood cells, and platelets (cells that help blood clot) in your bloodAntibody tests to find out if your immune system is attacking healthy tissueBlood clotting time tests to see if you have clotting problemsComplement tests to check for signs of inflammationUrine testsUrine (pee) tests can help doctors see if there are problems with your kidneys. Your doctor may test your urine once or test it many times to check for changes.BiopsiesDoctors may remove a small piece of tissue (what your organs are made of) from different parts of your body, like your skin. Then they can check that tissue to see if there are any signs of inflammation and damage.Learn more about lab tests for lupusWhat happens if I get diagnosed with lupus?If you get diagnosed with lupus, you can work with your doctor to make a treatment plan. There’s no cure for lupus, but there are ways to stay on top of your health and manage your symptoms.Learn about treatments for lupusFor more information about diagnosing lupus, visit the National Resource Center on Lupus.Victoria’s road to diagnosisVictoria Gibbs experienced strange symptoms for months before she finally got a…

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How Is Lupus Diagnosed? – WebMD

How Is Lupus Diagnosed? Menu By Mary Anne DunkinLupus is difficult to diagnose because its symptoms can be vague. And unlike other diseases, doctors can’t diagnose it with a single lab test.But your doctor can look at your symptoms and family history and then use lab tests to confirm a diagnosis of lupus.Blood tests and other tests can also help monitor the disease and show the effects of treatment.Look Out for SymptomsThe first step in the diagnosis of lupus is to figure out your symptoms.The symptoms of lupus vary widely between people. To confuse matters, many of the symptoms can also be caused by other conditions like diabetes or arthritis. They can even “flare up” and then go away for no apparent reason.These are some of the reasons why lupus can be so hard to diagnose. Still, there are some symptoms that seem to be more common with lupus.One common symptom is a rash or rashes. You may have a typical “butterfly rash” that covers each cheek and joins at the bridge of your nose. Or you might have rashes elsewhere on your hands, wrists, or face. They’re often itchy and typically happen after a long time in the sun. Some may fade and some stick around for a long time.Other common symptoms include:Muscle and joint painSwollen glandsFeverSensitivity to sunlight, especially long exposureLoss of hair (often due to scalp rashes and scarring)Mouth soresDry eyesUnexplained tirednessUnexplained stomach, chest, or head painBreathing problems (see your doctor immediately for this)Brain fogDepressed moodVisit Your Doctor About Any SymptomsIf you notice any of these symptoms, talk to your health care provider. They will examine you and ask you about them in detail. You may consider keeping track of your symptoms in a journal over a period of time in order to give your doctor the most accurate information.They will also ask about your family medical history to see if lupus runs in your family. If they suspect lupus, they will start to look for confirmation with lab tests of your blood and urine.Blood Tests for LupusAntinuclear Antibody (ANA)What it is: ANA is a type of antibody directed against the cells’ nuclei.Why the test is used: ANA is present in nearly everybody with active lupus. Doctors often use the ANA test as a screening tool. Plus, looking at patterns of the antibodies can sometimes help doctors determine the specific disease a person has. That, in turn, helps determine which treatment would be most appropriate.Limitations of the test: Although almost all people with lupus have the antibody, a positive result doesn’t necessarily indicate lupus. Positive results are often seen with some other diseases and in a smaller percentage of people without lupus or other autoimmune disorders. So a positive ANA by itself is not enough for a lupus diagnosis. Doctors must consider the result of this test along with other criteria. Antiphospholipid Antibodies (APLs)What it is: APLs are a type of antibody directed against phospholipids.Why the test is used: APLs are present in up to 60% of people with lupus. Their presence can help confirm a…

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How is lupus diagnosed?

How is lupus diagnosed? : Johns Hopkins Lupus Center Because lupus can produce a variety of symptoms in different individuals, it may take some time for a physician to actually make the diagnosis. Often a doctor will say that lupus might be present, but that the current symptoms are insufficient to signify a firm diagnosis. In this event, s/he will likely monitor the patient’s symptoms, signs, and lab tests closely over time and have him/her return for regular visits. No single finding qualifies an individual as having SLE. Instead, the American College of Rheumatology (ACR) has devised certain classification criteria, and four or more of these criteria must be present for a classification of lupus. [The term “classification” is not synonymous with “diagnosis.” “Classification” means that reasonable certainty exists for the diagnosis of lupus for research purposes.] Although, these criteria are currently being updated, they are believed to be about 90% effective. The ACR criteria include malar rash; discoid rash; photosensitivity (development of a rash after sun exposure); oral or nasal ulcers; arthritis of multiple joints; serositis: (inflammation of the lining around the lungs or heart); kidney disease indicated by protein or casts in the urine; neurological disorders such as seizures and psychosis; and blood disorders such as hemolytic anemia, leukopenia, and lymphopenia. Other signs that are common but not included in the classification criteria are hair loss or breaking, especially around the forehead, and Raynaud’s Phenomenon, a two- or three-color change of the fingertips upon cold exposure. Although no one symptom qualifies someone as having lupus, certain clinical techniques can be used to narrow down the diagnosis. For example, a test for antinuclear antibodies (ANAs) in the blood is probably the first tool a physician will use. A positive ANA test does not necessarily mean that someone has lupus; in fact, one out of five normal women has a positive ANA. However, a negative ANA test greatly reduces the suspicion. Disease indices Other sets of criteria, known as disease activity indices, exist for the monitoring of lupus. These forms allow a physician examining a patient to check for the improvement or worsening of the disease. These forms include the BILAG (British Isles Lupus Assessment Group Index), SLEDAI (Systemic Lupus Erythematosus Disease Activity Index), SLAM (Systemic Lupus Activity Measure), ECLAM (European Consensus Lupus Activity Measurement), and the Lupus Activity Index (LAI). Sometimes these indices will show no signs of lupus, even when the patient feels badly. This is because some of the problems that occur in lupus, such as chronic fatigue and pain, are not tracked by the indices. Instead, these symptoms represent a co-occuring problem called fibromyalgia. Other similar conditions Since other diseases and conditions appear similar to lupus, adherence to classification can greatly contribute to an accurate diagnosis. However, the absence of four of these criteria does not necessarily exclude the possibility of lupus. When a physician makes the diagnosis of SLE, s/he must exclude the possibility of conditions with comparable symptoms, including rheumatoid arthritis, systemic sclerosis (scleroderma),…

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Lupus Diagnosis | Johns Hopkins Medicine

Lupus Diagnosis Autoimmune Systemic Lupus Erythematosus How is lupus diagnosed?To evaluate if you have lupus, your doctor will review your lupus organ involvement against a specific set of criteria, called SLICC (or they may use the ACR criteria, from the American College of Rheumatology).There isn’t a single test for lupus, so your doctor will need to gather a lot of information in a variety of ways, starting with your medical history.Next, your doctor will do an exam and look for some of the physical signs of lupus. He or she may also order a biopsy — a procedure done to remove a small piece of your skin and/or your kidney for examination under a microscope. The doctor will also ask for blood, urine and other tests to see if and how your organs have been affected.Tests to Make a Lupus DiagnosisSeveral tests can help your doctor determine if you have lupus and — if you do have it — its severity. You will usually have the following tests. The details they gather are all pieces of the puzzle that can lead to a lupus diagnosis.Complete blood count (CBC): checks for low counts of red blood cells, white blood cells and platelets.Complement tests: measures the level of complement — proteins in your blood that help destroy foreign substances. Low levels of complement can indicate lupus.Chemistry panel: assesses your kidney and liver functions.Urinalysis and urine protein-to-creatinine ratio: assesses for lupus of the kidneys.Lupus autoantibody tests: tests for anti-dsDNA, anti-Sm, anti-RNP, anti-Ro, anti-La, Coombs and antiphospholipid antibodies.After a Lupus DiagnosisOnce you’ve been diagnosed with lupus and you know the type you have, you’ll work with your doctor to develop a treatment plan. Your plan will be specific for your needs, considering the type of lupus you have, how serious it is and its effect on your body. This plan will need to be adjusted and changed as your lupus signs change.

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Lupus Blood Test Results: What to Know | HSS Rheumatology

Lupus Blood Test Results: What to Know | HSS Rheumatology Patients with suspected or confirmed systemic lupus erythematosus (“lupus” or SLE) undergo laboratory tests (blood tests) for multiple reasons. Physicians and other health care professionals test patients periodically and use the information derived from the tests in various ways. Uses for laboratory tests Laboratory tests for autoantibodies in lupus Uses for laboratory tests To diagnose: Lupus symptoms often mimic those of other diseases and vice versa. Physicians use medical history, physical examination and laboratory findings to confirm the diagnosis. To determine prognosis: Physicians want to understand how a patient’s disease will progress. Laboratory tests are used to establish a baseline at the time of diagnosis and to predict whether lupus is likely to improve or worsen. To monitor: Laboratory tests help physicians assess the severity of the disease, the efficacy of treatment, and medication-related side effects. To guide therapy: Laboratory tests help physicians make treatment recommendations and adjust for changing symptoms. Laboratory tests for autoantibodies in lupus Antinuclear antibody (ANA) Antinuclear antibody (ANA) autoantibodies, or antibodies produced by the immune system that attack the body’s own cells, are a hallmark of lupus. ANA is usually measured as 0 to 4+ or as a titer (the number of times a blood sample can be diluted and still be positive). ANA of 0, 1+ or 2+, or at titers less than 1:80 (diluted 80 times) usually do not indicate a significant problem. ANA titers at higher levels more likely indicate the presence of autoimmune disease. Many laboratories also measure pattern or the way the test looks when viewed through a microscope. Different ANA patterns may correspond with different characteristics of lupus. ANA is a screening test, since almost all patients with lupus have a strongly positive test. However, a positive ANA test result does not by itself confirm a diagnosis for lupus. About 10% of people who do not have an autoimmune disease, as well as many who have other autoimmune diseases (such as thyroid disease) also have positive ANA tests, but usually less strongly positive. Once a person has a positive result, their ANA generally remains positive, so future ANA tests need not be repeated. Anti-double-stranded DNA (dsDNA) The anti-double-stranded DNA (dsDNA) antibody is named for its ability to bind to the normal DNA in patients’ cells. At high titers, this antibody is almost exclusively specific to people who have lupus. Low titers can occur in other rheumatic diseases, like rheumatoid arthritis and primary antiphospholipid syndrome. Sometimes, family members of people who have lupus may also test positive themselves, even though they do not have lupus. About 80% of patients with active, untreated lupus have a positive anti-dsDNA test. Monitoring anti-dsDNA is important, since levels may vary along with symptoms of disease, high titers indicating active disease, low titers quiescent disease. (However, anti-DNA antibody levels remain high in some patients with lupus who are well and do not need treatment.) Laboratories vary in how they report the test. Some do so as a range of 0 to 4+ (0, 1+, and 2+ are low titers; 3+ and 4+ are high), others as…

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Lupus – American College of Rheumatology

LupusSystemic lupus erythematosus, referred to as SLE or lupus, is a chronic (long-term) disease that causes systemic inflammation which affects multiple organs. In addition to affecting the skin and joints, it can affect other organs in the body such as the kidneys, the tissue lining the lungs (pleura), heart (pericardium), and brain. Many patients experience fatigue, weight loss, and fever. Lupus flares vary from mild to serious. Most patients have times when the disease is active, followed by times when the disease is mostly quiet – referred to as a remission. Yet, there is much reason for hope. Improvements in treatment have greatly improved these patients’ quality of life and increased their lifespan. What Causes Lupus? When healthy, our immune system protects the body from germs and cancers. With lupus, the immune system misfires and attacks “self”, the patient’s own tissues, in a process called autoimmunity or “loss of self-tolerance”. In lupus as the attack goes on, all the branches of the immune system join the fight. This leads to significant and intense inflammation. The cause of lupus is unknown, as well as what drives its diverse presentation. We know that multiple factors are required, including: the “right” genetic makeup, environmental exposures and organ specific characteristics. People with lupus may also have an impaired process for clearing old and damaged cells from the body, which in turn provides continuous stimuli to the immune system and leads to abnormal immune response. Most often, lupus starts in young females in their fertility age, although it can sometimes start during childhood (see section on Childhood-onset lupus below). The disease is more common in some ethnic groups, mainly blacks and Asians, and tends to be worse in these groups. About 20% of people with lupus develop the disease as children or teens. When lupus starts in childhood, it is called childhood-onset SLE, or cSLE. It is rare to get lupus before age 5 years. How Is Lupus Diagnosed? Lupus can be hard to detect because it is a complex disease that has many symptoms, and they can come on slowly. As experts in diagnosing and treating autoimmune diseases such as lupus, rheumatologists can best determine whether a patient has lupus and advise them about treatment options. People with lupus often have symptoms that are not specific to lupus. These include fever, fatigue, weight loss, blood clots and hair loss. They may also have heartburn, stomach pain and poor circulation to the fingers and toes. Pregnant women can have miscarriages. Lupus can flare during pregnancy and can affect its outcome. The American College of Rheumatology has a list of symptoms and other measures that doctors can use as a guide to decide if a patient with symptoms has lupus. Rashes: Butterfly-shaped rash over the cheeks – referred to as malar rash Red rash with raised round or oval patches – known as discoid rash Rash on skin exposed to the sun Mouth sores: sores in the mouth or nose lasting from a few days to more than a month Arthritis: tenderness and swelling lasting for a few weeks in two or more joints Lung or heart inflammation: swelling of the tissue lining the lungs (referred to as pleurisy or pleuritis) or the heart (pericarditis), which can cause chest pain when breathing deeply Kidney problem: blood or protein in the urine, or tests that suggest poor kidney function Neurologic problem: seizures, strokes or psychosis (a mental health problem) Abnormal blood tests such as: Low blood cell counts:…

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How Lupus Is Diagnosed | Everyday Health

How Lupus Is DiagnosedWhat to Expect When You See the RheumatologistIf your doctor does refer you to a rheumatologist because he or she suspects lupus, patients can expect a thorough medical history and complete physical examination, as well as several laboratory tests, says Kramer.There’s no one test for lupus, so the rheumatologist will typically use a combination of test results and the signs and symptoms you report to make a diagnosis, adds Francis Luk, MD, an assistant professor in the Wake Forest School of Medicine department of internal medicine, section of rheumatology, in Winston-Salem, North Carolina.Symptoms are subjective and include pain levels and how much fatigue a person is experiencing. Signs are measurable and can include rash or swelling of the joints, he says.Lab Tests the Doctor Might RuFor lab tests, a blood draw for a complete blood count, which measures levels of the red blood cells, white blood cells, and platelets is standard, says Kramer. Notably, these blood cell levels may be low in people with lupus. (1)A urinalysis, a test of the urine, is also standard for assessing kidney function, says Kramer. Bits of cells called cell casts and large or abnormal amounts of protein in the urine are signs that the kidneys are not doing their job of filtering waste from the blood properly. Inflammation of the kidneys, or lupus nephritis, is a complication of lupus, too; these are all things doctors are on the lookout for. (1)Rheumatologists also look for certain antibodies, or proteins, in your blood to help diagnose lupus, says Kramer. In healthy people, antibodies fight off foreign invaders such as viruses, bacteria, and fungi. People with lupus produce autoantibodies, which are antibodies that attack the body’s own cells and tissues. (2) Laboratory tests check for the following:Antinuclear Antibodies (ANA) These proteins bind to the cell nucleus, damaging the cell or causing it to die. About 97 percent of people with lupus have these antibodies. (1)Anti-Double-Stranded DNA Antibodies These proteins are a type of anti-nuclear antibody that bind to the DNA, or genetic material, inside the cell nucleus. About half of people with lupus have these antibodies. (3)Antibodies to Sm These antibodies target proteins called Sm in the cell nucleus. This antibody type is present in up to 40 percent of people with lupus. (3)Antiphospholipid Antibodies These antibodies can cause narrowing of the blood vessels. About a third of people with lupus test positive for antiphospholipid antibodies. (3)Complement Proteins These proteins boost the body’s immune response to infections. The inflammation that lupus causes can lead to low complement levels, which is why your rheumatologist might run tests of your levels to help identify lupus. (3)Other Medical Tests That Help Rheumatologists Diagnose LupusOther tests for lupus can depend on the symptoms patients are experiencing, says Stuart Kaplan, MD, a rheumatologist at Mount Sinai South Nassau in Oceanside, New York. For example, chest X-rays and echocardiograms may be necessary to indicate whether a patient has pleuritis or pericarditis if individuals have chest pain or shortness of breath (both symptoms indicate those conditions might be happening). If doctors suspect nephritis is present, the patient may need a kidney biopsy, he says.

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