Diagnosis of Lupus

This site is intended for healthcare professionals as a useful source of information on the diagnosis, treatment and support of patients with lupus and related connective tissue diseases.
Diagnosis of lupus or any other chronic illness may be established using the 5 Step Programme.

1. Review patient symptoms
2. Detailed physical examination
3. Battery of tests
4. Rule out other diseases
5. Time is sometimes necessary to observe the course of the disease

The First Principle in making a diagnosis of lupus is that the individual has clinical evidence of a multisystem disease and several manifestations such as those listed below may be present:

SKIN Rashes, Mouth Ulcers, Hair Loss

JOINTS Pain, redness and swelling

KIDNEY Abnormal Urinanalysis

LINING MEMBRANE Pleurisy, Pericarditis, Peritonitis

BLOOD Haemolytic Anaemia, Leukopenia

LUNGS Shortness of breath, cough

NERVOUS SYSTEM Convulsions, psychosis

The Second Principle is to examine the status of the immune system and how the cells that comprise the immune system are functioning in individuals having a suspicious clinical history. The most useful test is the ANA (Anti-Nuclear Antibody) test, supported by, and in combination with, the clinical history.
The onset of lupus can be gradual with new and different symptoms appearing over weeks, months or even years. The symptoms are often hard to describe and can come and go suddenly, therefore, it may often be that the patient might begin to feel "it is all in the mind". As a consequence, such patients are frequently categorised as hypochondriacs.

The symptoms of lupus seem to fall into two categories, non-specific and specific.

Non-Specific Symptoms

1. Fatigue - the most frequent symptom that affects people with lupus
2. Weight Loss
3. Weight Gain - may be caused by swelling related to organ involvement
4. Fever - indication that lupus is becoming active
5. Swollen Glands

Other additional problems commonly experienced by patients may be high blood pressure, headaches, vasculitis, increase in hair loss, miscarriage and Raynaud's Phenomenon.

Specific Symptoms

To help distinguish lupus from other diseases, physicians of the American College of Rheumatology have established a list of 11 criteria which, when combined, point to lupus.

To make a diagnosis of lupus the patient must have had at least four of these 11 criteria at any time since the onset of the disease.

1. Malar rash - fixed red rash over the cheeks
2. Discoid rash - red patches of skin associated with scaling and plugging of the hair follicles
3. Photosensitivity - rash after exposure to sunlight
4. Mucosal ulcers - small sores that occur in mucosal lining of mouth and nose
5. Serositis - inflammation of the serosal surfaces – pleura, pericardium, peritoneum
6. Arthritis - very common in lupus
7. Renal disorder - usually detected by routine blood and urine analysis
8. Neurological disorder - seizures or psychosis
9. Haematological disorder - Haemolytic Anaemia, Leukopenia, Lymphopenia, Thrombocytopenia
10. Immunological disorder - tests on LE cells, anti-DNA and anti-Sm antibodies
11. Anti-Nuclear Antibody (ANA test) - when found in the blood and the patient is not taking drugs, it is known to cause a positive test for lupus, being found in less than 97% of patients, but is not necessarily conclusive.