From the Guidelines
Lupus diagnosis should be based on a combination of clinical symptoms, physical examination findings, and laboratory tests, with a focus on the overall pattern of symptoms and test results evaluated together, as recommended by the most recent guidelines 1. The diagnosis of lupus is a complex process that involves the evaluation of multiple factors, including clinical symptoms, physical examination findings, and laboratory tests. According to the 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus, lupus is a multisystem disease that is diagnosed on clinical grounds in the presence of characteristic serological abnormalities 1. The American College of Rheumatology has established a set of criteria that includes malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, kidney disorder, neurological disorder, blood disorder, immunologic disorder, and positive antinuclear antibody (ANA) test.
- The ANA test is usually the first screening test, with over 95% of lupus patients testing positive, though a positive result alone isn't diagnostic.
- Additional blood tests may include anti-double-stranded DNA antibodies, anti-Smith antibodies, complete blood count, kidney and liver function tests, urinalysis, and complement levels.
- Sometimes tissue biopsies from affected organs like skin or kidneys may be necessary.
- Since lupus symptoms can mimic other conditions, diagnosis often takes time and may require consultation with a rheumatologist.
- There's no single definitive test for lupus, so diagnosis relies on the overall pattern of symptoms and test results evaluated together. The use of anti-dsDNA autoantibodies in the diagnosis and follow-up of systemic lupus erythematosus is also an important aspect of lupus diagnosis, as recommended by a panel of experts in 2023 1.
- Anti-dsDNA autoantibodies are listed as one of the classification criteria for systemic lupus erythematosus and are relatively effective indicators for monitoring disease activity and treatment response.
- However, the use of anti-dsDNA antibodies is not free from controversy, and their determination still lacks proper standardization.
- The detection of ANA is the first level test for laboratory diagnosis of SARD, and ANA testing is primarily intended for diagnostic purposes, and not for monitoring disease progression, as recommended by international guidelines in 2014 1. In summary, lupus diagnosis should be based on a combination of clinical symptoms, physical examination findings, and laboratory tests, with a focus on the overall pattern of symptoms and test results evaluated together, as recommended by the most recent guidelines 1.
From the Research
Lupus Diagnosis
- Systemic lupus erythematosus (SLE) is an autoimmune inflammatory condition that may involve multiple organ systems 2
- The antinuclear antibody (ANA) test is positive in nearly every case of SLE, but it is not specific for this disease and must be interpreted in the appropriate clinical context 2
- Key features that warrant ANA testing include:
- Unexplained multisystem inflammatory disease
- Symmetric joint pain with inflammatory features
- Photosensitive rash
- Cytopenias 2
- ANA staining patterns and more specific autoantibody testing may be helpful in diagnosis of suspected SLE or ANA-associated disease 2
Treatment Options
- Belimumab, a monoclonal antibody that binds and neutralizes the B cell survival factor BAFF, has been approved for treatment of SLE 3
- Rituximab, a monoclonal antibody that binds to CD20 on the surface of B cells, has been extensively studied for the treatment of SLE, but its use remains off-label 3
- Hydroxychloroquine (HCQ) has demonstrated several crucial properties for the treatment of SLE, including decreasing SLE activity, preventing disease flare, and lowering the long-term glucocorticoid need 4
- HCQ is now the mainstay long-term treatment in SLE, recommended by current guidelines in all patients unless contraindications or side effects 4