Lupus Diagnosis
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Diagnosis of Lupus can be somewhat difficult. There are no definitive tests for
diagnosing Lupus. Many of the symptoms and laboratory test results of Lupus patients are
similar to those of patients with different diseases, including rheumatoid arthritis,
multiple sclerosis, and various nervous system and blood disorders.
Tests used in lupus diagnosis
- antinuclear antibody (ANA) panel including anti-DNA and anti-Smith antibodies, with the
latter two tests generally positive in lupus alone
- characteristic skin rash or lesions
- chest X-ray showing pleuritis or pericarditis
- listening to the chest with a stethoscope to reveal heart friction rub or pleural
friction rub
- urinalysis to show blood, casts, or protein in the urine
- CBC showing a decrease in some cell types
- kidney biopsy
- neurological examination
Other test that may be used for a lupus diagnosis
- WBC count
- serum globulin electrophoresis
- rheumatoid factor
- protein, urine
- protein electrophoresis - serum
- mononucleosis spot test
- ESR
- cryoglobulins
- Coombs' test, direct
- complement component 3 (C3)
- complement
- antithyroid microsomal antibody
- antithyroglobulin antibody
- antimitochondrial antibody
- anti-smooth muscle antibody
Lupus Diagnosis - Laboratory tests
Laboratory tests that are helpful in diagnosing Lupus include several tests for a
variety of antibodies commonly elevated in Lupus patients (including antinuclear
antibodies, anti-DNA antibodies, etc.). Lupus patients tend to have low numbers of red
blood cells (anemia) and low numbers of certain types of white blood cells. The
erythrocyte sedimentation rate (ESR), a measure of inflammation in the body, tends to be
quite elevated. Samples of tissue (biopsies) from affected skin and kidneys show
characteristics of the disease.
A test called the lupus erythematosus cell preparation (or LE prep) test is also
performed. This test involves obtaining a sample of the patient's blood. Cells from the
blood are damaged in the laboratory in order to harvest their nuclei. These damaged cells
are then put together with the patient's blood serum, the liquid part of blood separated
from the blood cells. Antinuclear antibodies within the patient's serum will clump
together with the damaged nuclear material. A material called Wright's stain will cause
these clumps to turn blue. These stained clumps are then reacted with some of the
patient's white blood cells, which will essentially eat the clumps. LE cells are the white
blood cells that contain the blue clumps. This test will be positive in about 70-80% of
all patients with Lupus.
Lupus Diagnosis by evaluation of symptoms
The American Rheumatism Association developed a list of symptoms used to diagnose
Lupus. Research supports the idea that people who have at least four of the eleven
criteria (not necessarily simultaneously) are extremely likely to have Lupus. The criteria
are:
- Butterfly rash
- Discoid rash
- Photosensitivity
- Mouth ulcers
- Arthritis
- Inflammation of the lining of the lungs or the lining around the heart
- Kidney damage, as noted by the presence of protein or other abnormal substances called
casts in the urine
- Seizures or psychosis
- The presence of certain types of anemia and low counts of particular white blood cells
- The presence of certain immune cells, anti-DNA antibodies, or a falsely positive test
for syphilis
- The presence of antinuclear antibodies.
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