Diagnosis of Lupus
Diagnostic Test list for Lupus:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Lupus
includes:
Lupus Diagnosis: Book Excerpts
Tests and diagnosis discussion for Lupus:
The Many Shades of Lupus: NIAMS (Excerpt)
Go see a doctor. He or she will talk to you and take a
history of your health problems. Many people have lupus for a long time
before they find out they have it. It's important that you tell the
doctor or nurse about your symptoms. This information, along with a
physical examination and the results of laboratory tests, helps the
doctor decide whether you have lupus or something else.
A rheumatologist (ROOM-uh-TALL-uh-jist) is a doctor who
specializes in treating diseases that affect the joints and muscles,
like lupus. You may want to ask your regular doctor for a referral to a
rheumatologist.
In some cases, a dermatologist, a doctor who specializes
in treating diseases that affect the skin, may be involved in diagnosis
and treatment. No single test can show that you have lupus. Your
doctor may have to run several tests and study your medical history. It
may take time for the doctor to diagnose lupus.
(Source: excerpt from The Many Shades of Lupus: NIAMS)
Handout on Health Systemic Lupus Erythematosus: NIAMS (Excerpt)
Diagnosing lupus can be difficult. It may take months or
even years for doctors to piece together the symptoms to diagnose this
complex disease accurately. Making a correct diagnosis of lupus requires
knowledge and awareness on the part of the doctor and good communication
on the part of the patient. Giving the doctor a complete, accurate
medical history (for example, what health problems you have had and for
how long) is critical to the process of diagnosis. This information,
along with a physical examination and the results of laboratory tests,
helps the doctor consider other diseases that may mimic lupus, or
determine if the patient truly has the disease. Reaching a diagnosis may
take time and occur gradually as new symptoms appear.
No single test can determine whether a person has lupus,
but several laboratory tests may help the doctor to make a diagnosis.
The most useful tests identify certain autoantibodies often present in
the blood of people with lupus. For example, the antinuclear antibody
(ANA) test is commonly used to look for autoantibodies that react
against components of the nucleus, or "command center," of the patient’s
own cells. Most people with lupus test positive for ANA; however, there
are a number of other causes of a positive ANA besides lupus, including
infections, other rheumatic or immune diseases, and occasionally as a
finding in normal healthy adults. The ANA test simply provides another
clue for the doctor to consider in making a diagnosis. In addition,
there are blood tests for individual types of autoantibodies that are
more specific to people with lupus, although not all people with lupus
test positive for these and not all people with these antibodies have
lupus. These antibodies include anti-DNA, anti-Sm, anti-RNP, anti-Ro
(SSA), and anti-La (SSB). The doctor may use these antibody tests to
help make a diagnosis of lupus.
Some tests are used less frequently but may be helpful if
the cause of a person’s symptoms remains unclear. The doctor may order a
biopsy of the skin or kidneys if those body systems are affected. Some
doctors may order a syphilis test or a test for anticardiolipin
antibody. A positive test does not mean that a patient has syphilis;
however, the presence of this antibody may increase the risk of blood
clotting and can increase the risk of miscarriages in pregnant women
with lupus. Again, all these tests merely serve as tools to give the
doctor clues and information in making a diagnosis. The doctor will look
at the entire picture--medical history, symptoms, and test results--to
determine if a person has lupus.
Other laboratory tests are used to monitor the progress of
the disease once it has been diagnosed. A complete blood count,
urinalysis, blood chemistries, and erythrocyte sedimentation rate (ESR)
test can provide valuable information. Another common test measures the
blood level of a group of substances called complement. People with
lupus often have increased ESRs and low complement levels, especially
during flares of the disease.
|
Diagnostic Tools for Lupus
- Medical history
- Complete physical examination
- Laboratory tests:
- Complete blood count
- Erythrocyte sedimentation rate (ESR)
- Urinalysis
- Blood chemistries
- Complement levels
- Antinuclear antibody test (ANA)
- Other autoantibody tests (anti-DNA, anti-Sm,
anti-RNP, anti-Ro [SSA], anti- La [SSB])
- Syphilis test or anticardiolipin antibody
|
(Source: excerpt from
Handout on Health Systemic Lupus Erythematosus: NIAMS)
Lupus Fact Sheet: NWHIC (Excerpt)
Early diagnosis and treatment are needed to improve health and reduce tissue
damage. Diagnosing lupus can be difficult, however, because it may take months
or even years for doctors to piece together the symptoms to make an accurate
diagnosis. Giving the doctor a complete, accurate medical history is critical to
the process of diagnosis. This information, along with a physical examination
and the results of laboratory tests, helps the doctor rule out other diseases
that may mimic lupus. Reaching a diagnosis may take time and occur gradually as
new symptoms appear. (Source: excerpt from Lupus Fact Sheet: NWHIC)
Diagnosis of Lupus: medical news summaries:
The following medical news items
are relevant to diagnosis and misdiagnosis issues for Lupus:
Diagnostic Tests for Lupus: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about diagnostis of Lupus.
Butterfly rash:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient when he first noticed the butterfly rash and if he has recently been exposed to the sun. Has he noticed a rash elsewhere on his body? Also, ask about recent weight or hair loss. Does he have a family history of lupus? Is he taking hydralazine or procainamide (common causes of drug-induced lupus erythematosus [LE])?
Inspect the rash, noting any macules, papules, pustules, or scaling. Is the rash edematous? Are areas of hypopigmentation or hyperpigmentation present? Look for blisters or ulcers in the mouth, and note any inflamed lesions. Check for rashes elsewhere on the body.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Lupus erythematosus:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Diagnostic tests for patients with SLE include a complete blood count with differential (for signs of anemia and decreased white blood cell [WBC] count); platelet count (may be decreased); erythrocyte sedimentation rate (commonly elevated); and serum electrophoresis (may show hypergammaglobulinemia).
Specific tests for SLE include:
❑ antinuclear antibody panel, including anti-deoxyribonucleic acid (DNA) and anti-Smith antibodies — generally positive for lupus alone. (Because the anti-DNA test is rarely positive in other conditions, it’s the most specific test for SLE. However, if the patient is in remission, anti-DNA may be reduced or absent [correlates with disease activity, especially renal involvement, and helps monitor response to therapy]. Other tests may be performed as needed to rule out other disorders.)
❑ urine studies — may show RBCs and WBCs, urine casts and sediment, and significant protein loss (more than 0.5 g/24 hours)
❑ blood studies — decreased serum complement (C3 and C4) levels indicate active disease
❑ chest X-ray — may show pleurisy or lupus pneumonitis
❑ electrocardiogram — may show conduction defect with cardiac involvement or pericarditis
❑ kidney biopsy — determines disease stage and extent of renal involvement.
Some patients show a positive lupus anticoagulant test and a positive anticardiolipin test. Such patients are prone to antiphospholipid syndrome (thrombosis and thrombocytopenia).
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Butterfly rash:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient when he first noticed the butterfly rash and if he has recently been exposed to the sun. Has he noticed a rash elsewhere on his body? Also, ask about recent weight or hair loss. Does he have a family history of lupus? Is he taking hydralazine or procainamide (common causes of drug-induced lupus erythematosus)?
Inspect the rash, noting any macules, papules, pustules, or scaling. Is the rash edematous? Are areas of hypopigmentation or hyperpigmentation present? Look for blisters or ulcers in the mouth, and note any inflamed lesions. Check for rashes elsewhere on the body. (See Butterfly rash: Causes and associated findings.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Lupus erythematosus:
Diagnosis
(Handbook of Diseases)
Diagnostic tests for patients with SLE include a complete blood cell count with differential, which may show anemia and a decreased white blood cell (WBC) count; platelet count, which may be decreased; erythrocyte sedimentation rate, which may be elevated; and serum electrophoresis, which may show hypergammaglobulinemia.
Specific tests for SLE include the following:
❑ ANA, anti-double-stranded deoxyribonucleic acid (dsDNA), and lupus erythematosus cell tests are positive in patients with active SLE; because the anti-dsDNA test is rarely positive in those with other conditions, it’s the most specific test for SLE. However, if the patient is in remission, anti-dsDNA results may be reduced or absent (because anti-dsDNA correlates with disease activity, especially renal involvement, and helps monitor the patient’s response to therapy). Other autoantibodies commonly found include anti-SM (also highly specific for SLE), anti-SSA, anti-SSB, and anti-RNP.
❑ Urine studies may show red blood cells and WBCs, urine casts and sediment, and significant protein loss (more than 0.5 g/24 hours).
❑ Blood studies reveal decreased serum complement (C3 and C4) levels, which indicate active disease.
❑ Chest X-ray may show pleurisy or lupus pneumonitis.
❑ Electrocardiography may show a conduction defect with cardiac involvement or pericarditis.
❑ Kidney biopsy determines the stage of the disease and the extent of renal involvement.
Some patients show a positive lupus anticoagulant test and a positive anticardiolipin test. Such patients are prone to antiphospholipid syndrome (thrombosis, abortion, and thrombocytopenia).
UNDER STUDY: Researchers have noted a significant association between the presence of activated protein C resistance and thrombosis in patients with SLE.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Butterfly rash:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Ask the patient when he first noticed the butterfly rash and if he has recently been exposed to the sun. Has he noticed a rash elsewhere on his body? Also, ask about recent weight or hair loss. Does he have a family history of lupus? Is he taking hydralazine or procainamide (common causes of drug-induced lupus erythematosus)?
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Butterfly rash:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient when he first noticed the butterfly rash and if he has recently been exposed to the sun. Has he noticed a rash elsewhere on his body? Ask about recent weight or hair loss. Does he have a family history of lupus? Is he taking hydralazine or procainamide (common causes of drug-induced lupus erythematosus)?
Inspect the rash, noting any macules, papules, pustules, or scaling. Is the rash edematous? Are areas of hypopigmentation or hyperpigmentation present? Look for blisters or ulcers in the mouth, and note any inflamed lesions. Check for rashes elsewhere on the body.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Lupus Erythematosus:
Lupus Erythematosus - DIAGNOSIS
(The 5-Minute Pediatric Consult)
Diagnostic criteria: 4 of following 11 criteria, developed by the American College of Rheumatology, must be met to classify a patient as having SLE:
- Malar (butterfly) rash
- Discoid rash
- Photosensitivity
- Oral or nasal ulcers
- Arthritis
- Cytopenia: Anemia, leukopenia (<4,000/mm3), lymphopenia (<1,500/mm3), or thrombocytopenia (<100,000/mm3)
- Neurologic disease: Seizures or psychosis
- Nephritis: >0.5 g/d proteinuria or cellular casts
- Serositis: Pleuritis or pericarditis
- Immunologic disorder: Antibodies to double-stranded DNA, Smith nuclear antigen, LE-cell preparation, false-positive serologic test for syphilis, or antiphospholipid antibodies (anticardiolipin antibodies or positive lupus anticoagulation test)
- Positive ANA
>>>
» READ BOOK EXCERPT ONLINE »
Source: The 5-Minute Pediatric Consult, 2008
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