Lupus Symptoms, Can It Be Accurately Diagnosed?

Many of the symptoms of Lupus (systematic lupus erythematosus or SLE) mimic those of other illnesses, making it a hard disease to diagnose. How do physicians make that Lupus diagnosis?

According to the Lupus Foundation of America lupus is "a chronic incurable disease of the immune system and may cause joint & muscle pain, skin rash, photosensitivity, inflammation of membranes around the heart or lungs, anemia, other blood abnormalities, kidney involvement & other symptoms." Many of the symptoms of lupus mimic those of other illnesses, making it a hard disease to diagnose. How do physicians make that lupus diagnosis? There are three factors that are reviewed when considering a lupus diagnosis:

1. The patient's entire medical history

2. The patient's current symptoms

3. An analysis of results obtained in routine laboratory tests and also in some specialized tests that are related to immune status.

According to Morris Reichlin, MD, Professor of Medicine and Chief of the Immunology Section, University of Oklahoma Health Sciences Center Head, Arthritis and Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK., to make a diagnosis of SLE, an individual must show "clinical evidence of a multi-system disease (i.e. has shown abnormalities in several different organ systems)."

Following is a list of symptoms of SLE as reported by Dr. Reichlin:

Skin: butterfly rash; ulcers in the mouth; hair loss.

Joints: pain; redness and swelling.

Kidney: abnormal urinanalysis suggesting kidney disease.

Lining membranes: pleurisy; pericarditis and/or peritonitis (taken together this type of inflammation is known as polyserositis).

Blood: hemolytic anemia (the red cells are destroyed by autoantibodies); leukopenia (low white blood cell count); thrombocytopenia (low platelets).

Lungs: infiltrates that are transient.

Nervous system: convulsions; psychosis; nerve abnormalities that cause strange sensations or alter muscular control or strength.¹

Presently there is no one definitive test that will render a totally positive diagnosis of SLE, but there are many tests that aid in that diagnosis. The tests that are commonly used are:

1. The anti-nuclear antibody test (ANA): a test to determine if autoantibodies to cell nuclei are present in the blood.

2. The anti-DNA antibody test: to determine if the patient has antibodies to the genetic material in the cell.

3. The anti-Sm antibody test: to determine if there are antibodies to Sm, which is a protein found in the cell nucleus.

4. Tests to detect the presence of immune complexes in the blood.

5. Tests to examine the total level of serum complement -- a group of proteins which can occur in immune reactions -- and tests to assess the specific level of C3 and C4, two proteins of this group.

6. LE cell prep: An examination of the blood looking for a certain kind of cell which has ingested the swollen antibody-coated nucleus of another cell. This test is used less frequently than the ANA test, because the ANA is more sensitive for SLE than the LE cell prep.¹

Most patients who have systematic lupus will test positive using the ANA test. If the test results are negative, it strongly suggests that lupus is not the cause of the person's illness. However, a person can also test positive if they have another connective tissue disease or if they are being treated with patients being treated with certain drugs, including procainamide, hydralazine, isoniazid, and chlorpromazine. It is possible(20%) for healthy individuals to test positive with the ANA test. While some of these people will develop lupus eventually, most will not. As a person ages, there is a greater chance of having a positive ANA. So, we find that a positive ANA exclusively is never enough to diagnose lupus. Conversely, a negative ANA, although indicating no lupus, does not rule out the disease totally. If the ANA is positive in a person who is not feeling well and who has other symptoms or signs of lupus, the physician will probably want to conduct further tests for lupus. The physician may safely choose to ignore positive results in a person who is feeling well and in whom there are no other signs of lupus. A rheumatologist would be able to clarify the test results further.

For more information about lupus please contact:

Lupus Foundation of America, Inc.

1300 Piccard Drive, Suite 200

Rockville, MD 20850-4303

1. Laboratory Tests Used in the Diagnosis of Lupus

Lupus Foundation of America/September 2000.

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