From the Guidelines
A lupus workup should begin with a thorough history and physical examination, focusing on symptoms like fatigue, joint pain, rash, and organ involvement, and initial laboratory tests should include complete blood count, comprehensive metabolic panel, urinalysis, erythrocyte sedimentation rate, and C-reactive protein, as recommended by recent guidelines 1. The workup should also include specific autoantibody testing, particularly antinuclear antibody (ANA), which is positive in over 95% of lupus patients. If ANA is positive, follow-up with more specific tests including anti-double-stranded DNA, anti-Smith, anti-Ro/SSA, anti-La/SSB, and antiphospholipid antibodies. Complement levels (C3 and C4) are often decreased in active lupus. Additional testing may include chest X-ray, electrocardiogram, and renal function tests. For suspected organ involvement, specific tests like renal biopsy, pulmonary function tests, or brain MRI may be necessary. The diagnosis relies on clinical judgment using the American College of Rheumatology or Systemic Lupus International Collaborating Clinics classification criteria, which require multiple clinical and immunological criteria to be met, as outlined in recent studies 1. Early referral to a rheumatologist is recommended for diagnosis confirmation and treatment planning, as lupus can be challenging to diagnose due to its variable presentation and overlap with other autoimmune conditions. It is also important to consider the use of anti-dsDNA autoantibodies in the diagnosis and follow-up of systemic lupus erythematosus, as recommended by an expert panel 1. The use of anti-dsDNA antibodies can help in monitoring disease activity and treatment response, but it is essential to standardize the assays and interpret the results correctly. The European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) have published classification criteria for SLE, which can be used to guide diagnosis and treatment decisions 1. Overall, a comprehensive approach to lupus diagnosis and management is crucial to improve patient outcomes and reduce morbidity and mortality.