Lupus

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Diagnosis

The American College of Rheumatology has established the criteria for the classification of lupus. SLE is diagnosed if more than 4 of the following are present.

• Malar rash (butterfly-shaped rash across the cheeks and nose)
• Discoid lupus rash (scarring, round rashes found most commonly on the face and scalp)
• Photosensitivity (rash on sun exposed areas of the body due to exposure to sunlight)
• Mouth or nose ulcers (usually painless)
• Non-erosive arthritis (does not destroy the bones surrounding the joints), which occurs in 2 or more joints and causes tenderness, swelling, or effusion (increased amounts of fluid)
• Cardiopulmonary involvement (e.g., inflammation of the lining around the heart [pericarditis] and/or the lungs [pleurisy])
• Neurological disorder (e.g., seizures, psychosis with delirium and/or hallucinations)
• Kidney (renal) disorder (e.g., excessive protein in the urine [proteinuria], cellular casts in the urine)
• Blood disorder (e.g., hemolytic anemia, low white blood cell count, low platelet count)
• Immunologic disorder (e.g., antibodies to double stranded DNA, antibodies to Sm, antibodies to cardiolipin, and lupus anticoagulant)
• Antinuclear antibodies (ANA; positive test in absence of drugs known to induce a positive test)

Laboratory tests

There is no test that is used specifically to diagnose SLE; however, the disease may affect a number of test results.

Most patients with lupus test positive for anti-nuclear antibody (ANA); however, as many as 20% of healthy women also test positive for this antibody, so the test is not definitive for lupus.

Depending on which organ systems are affected, additional laboratory tests can be used to detect a specific abnormality (e.g., an elevated red blood cell count in the urine if the kidneys are affected) caused by lupus.

In some cases, a biopsy of the kidney or skin can be helpful in making a diagnosis of SLE. Biopsy involves removing a small sample of tissue for microscopic evaluation.

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