Systemic Lupus Erythematosus (SLE) is a very complex chronic illness. It is known as “the great imitator” because
its symptoms often mimic or resemble other illnesses from rheumatoid arthritis to Lyme disease, making lupus very difficult to diagnose.
To complicate matters, many symptoms of lupus can change or come and go suddenly. Combine that with the fact that unlike AIDS or Cancer, there is no single laboratory test that can determine if a person has lupus so it can often take years for a proper diagnosis to be made.
To make a lupus diagnosis, doctors first look for physical evidence of the condition, such as swelling of joints, skinrashes and lesions, especially the malar “butterfly” rash that may appear on the face. They will also look for laboratory evidence such as protein in the urine, fluid around the lungs or heart, or a skin biopsy that may reveal the presence of the disease. Doctors will examine the patient medical history and then may also have to run additional tests like blood and urine analysis and skin biopsies to rule out other diseases like Lyme Disease or diabetes.
Five Key Steps to Lupus Diagnosis are:
- Medical history. Keep track of your symptoms by writing them down so you can make sure to tell your doctor all the details.
- Family history of lupus or other autoimmune diseases. If lupus or other autoimmune diseases run in your family, you are more likely to develop an autoimmune condition yourself.
- Complete physical exam. Your doctor will look for rashes and other signs that something is wrong.
- Blood and urine tests. The antinuclear antibody (ANA) test can show if your immune system is more likely to make the autoantibodies of lupus. Urine analysis can show protein signaling kidney issues, common in lupus patients.
- Possible Skin or kidney biopsy Sometimes additional testing is needed so doctors perform a minor surgery to remove a sample of tissue. The tissue is then viewed under a microscope. Skin and kidney tissue looked at in this way can show signs of an autoimmune disease.
Because of the complicated nature of the disease, the American College of Rheumatology’s created “The Eleven Criteria of Lupus” to help doctors make—or exclude—a diagnosis of lupus.
Typically, four or more of the following criteria must be present to make a diagnosis of systemic lupus.
The “Eleven Criteria”
- Malar rash: rash across cheeks and nose, often in the shape of a butterfly
- Discoid (skin) rash: raised red patches that appear in the form of discs or circles.
- Photosensitivity: skin rash as result of unusual reaction to sunlight.
- Mouth or nose ulcers: usually painless.
- Arthritis: in two or more joints, along with tenderness, swelling, or effusion, however the bones around joints don’t get destroyed.
- Cardio-pulmonary involvement: inflammation of the lining around the heart (pericarditis) and/or lungs (pleuritis)
- Neurologic disorder: seizures and/or psychosis.
- Renal (kidney) disorder: excessive protein in the urine, or cellular casts in the urine.
- Hematologic (blood) disorder: anemia (low red blood cell count), leukopenia (low white blood cell count), lymphopenia (low level of specific white blood cells), or thrombocytopenia (low platelet count)
- Immunologic disorder: antibodies to double stranded DNA, antibodies to Sm, or positive antiphospholipid antibodies
- Abnormal Antinuclear antibodies (ANA) test: (even with an abnormal ANA, a person may not have active Lupus SLE. About five to ten percent of healthy women test positive for ANA )
Together, this information along with the five keys of diagnosing lupus can provide clues to your disease. It also can help your doctor rule out other diseases that can be confused with lupus.