Symptoms and Diagnosis of Lupus
article syndicated from NIAMS
updated about 1 year ago
Systemic lupus erythematosus (SLE, or lupus) is a chronic, inflammatory, multisystem disorder of the immune system. Lupus: A Patient Care Guide for Nurses and Other Health Professionals is concerned primarily with this form of lupus.
Symptoms of SLE
Early symptoms of SLE are usually vague, nonspecific, and easily confused with other pathological and functional disorders. Symptoms may be transient or prolonged, and individual symptoms often appear independently of the others. Moreover, a patient may have severe symptoms with few abnormal laboratory test results, and vice versa. A range of clinical symptoms are seen in patients with lupus over the lifetime of the disease.
Symptoms of SLE
- Arthralgia
- Arthritis
- Fever (>100 ?F)
- Skin rashes
- Anemia
- Kidney damage
- Pleurisy
- Facial rash
- Photosensitivity
- Alopecia (hair loss)
- Raynaud's phenomenon
- Seizures
- Mouth or nose ulcers
Diagnosis of SLE
The onset of lupus may be acute, resembling an infectious process, or it may be a progression of vague symptoms over several years. As a result, diagnosing SLE is often a challenge. A consistent, thorough medical examination by a doctor familiar with lupus is essential to an accurate diagnosis. This must include a complete medical history and physical examination, laboratory tests, and a period of observation (possibly years). The doctor, nurse, or other health professional assessing a patient for lupus must keep an open mind about the varied and seemingly unrelated symptoms that the patient may describe. For example, a careful medical history may show that sun exposure, use of certain drugs, viral disease, stress, or pregnancy aggravates symptoms, providing a vital diagnostic clue.
No single laboratory test can definitely prove or disprove SLE. Initial screening includes a complete blood count (CBC), liver and kidney screening panels, laboratory tests for specific autoantibodies (e.g., antinuclear antibodies [ANA]), a syphilis test (VDRL), urinalysis, blood chemistries, and erythrocyte sedimentation rate (ESR). Abnormalities in these test results will guide further evaluations. High-titer anti-nDNA antibody or anti-Sm antibody are important indications of lupus. Specific immunologic studies, such as those of complement components (e.g., C3 and C4) and other autoantibodies (e.g., anti-La and anti-Ro), are used to help evaluate the patient's immune status and to monitor the activity of the disease. At times, biopsies of the skin or kidney using immunofluorescent staining techniques can support a diagnosis of SLE (see Chapter 3, Laboratory Tests Used to Diagnose and Evaluate SLE, for further information). A variety of laboratory tests, X rays, and other diagnostic tools are used to rule out other pathologic conditions and to determine the involvement of specific organs. It is important to note, however, that any single test may not be sensitive enough to reflect the intensity of the patient's symptoms or the extent of the disease's manifestations.
The American College of Rheumatology (ACR), an organization of doctors and associated health professionals who specialize in arthritis and related diseases of the bones, joints, and muscles, has developed and refined a set of diagnostic criteria. If at least 4 of the 11 criteria develop at one time or individually over any period of observation, then the patient is likely to have SLE. However, a diagnosis of SLE can be made in a patient having fewer than four of these symptoms.
ACR Criteria for Diagnosing SLE
- Malar rash
- Discoid rash
- Photosensitivity
- Oral ulcers
- Arthritis
- Serositis (pleuritis or pericarditis)
- Renal disorder (persistent proteinuria or cellular casts)
- Neurological disorder (seizures or psychosis)
- Hematologic disorder (anemia, leukopenia or lymphopenia on two or more occasions, thrombocytopenia)
- Immunologic disorder (positive LE cell preparation, abnormal anti-DNA or anti-Sm values, false-positive VDRL syphilis test)
- Abnormal ANA titer
Source: Tan E. The 1982 required criteria for the classification of systemic lupus erythematosus. Arthritis and Rheumatism 1982;25:1271-1277. ? 1982 American College of Rheumatology. Used with permission of Lippincott-Raven Publishers.
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