From the Guidelines
A lupus workup begins with a comprehensive medical history, physical examination, and laboratory tests including complete blood count, comprehensive metabolic panel, urinalysis, erythrocyte sedimentation rate, C-reactive protein, and specific lupus markers such as antinuclear antibody (ANA), anti-double-stranded DNA, and complement levels (C3 and C4) 1. If ANA is positive, additional autoantibody tests like anti-Smith, anti-Ro/SSA, and anti-La/SSB should be ordered. Imaging studies may be necessary depending on organ involvement. Treatment is tailored to disease severity and organ involvement, starting with hydroxychloroquine (200-400 mg daily) as the foundation for most patients, which reduces flares and organ damage 1. For mild to moderate symptoms, NSAIDs like ibuprofen (400-800 mg three times daily) or naproxen (250-500 mg twice daily) may help manage joint pain and inflammation. Corticosteroids such as prednisone (5-60 mg daily depending on severity) are used for acute flares. Immunosuppressants including methotrexate (7.5-25 mg weekly), azathioprine (50-150 mg daily), or mycophenolate mofetil (1-3 g daily) are added for organ-threatening disease 1. Belimumab may be considered for patients with active disease despite standard therapy 1. Sun protection, regular monitoring of medication side effects, and addressing comorbidities like cardiovascular disease risk factors are essential components of ongoing management. Key considerations in the management of lupus nephritis include the use of mycophenolic acid or low-dose intravenous cyclophosphamide as initial treatment, with the goal of achieving complete renal response and preventing disease flares 1. The treatment approach should be individualized based on disease severity, organ involvement, and patient-specific factors, with ongoing monitoring and adjustment of therapy as needed to optimize outcomes. Early diagnosis and treatment are crucial to prevent organ damage and improve long-term outcomes. Some of the key points to consider in the initial workup and treatment of lupus include:
- Comprehensive medical history and physical examination
- Laboratory tests, including complete blood count, comprehensive metabolic panel, urinalysis, and specific lupus markers
- Imaging studies as needed
- Hydroxychloroquine as the foundation of treatment
- NSAIDs and corticosteroids for symptom management
- Immunosuppressants for organ-threatening disease
- Belimumab for active disease despite standard therapy
- Ongoing monitoring and adjustment of therapy to optimize outcomes.
From the Research
Initial Lupus Workup
The initial steps for a lupus workup involve a combination of clinical evaluation, laboratory tests, and imaging studies. The following are some of the key components:
- Complete medical history and physical examination to identify symptoms and signs of lupus, such as fever, fatigue, joint pain, and skin rashes 2
- Laboratory tests, including:
- Complete blood count (CBC) to check for anemia, leukopenia, and thrombocytopenia 3, 4
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to assess inflammation 3
- Serum chemistry tests, such as liver and kidney function tests 3, 4
- Urinalysis to check for proteinuria, hematuria, and casts 4
- Serum complement levels, such as C3 and C4 3, 5
- Anti-nuclear antibody (ANA) test to check for the presence of autoantibodies 6
- Anti-dsDNA antibody test to check for the presence of specific autoantibodies associated with lupus 5, 6
- Imaging studies, such as chest X-ray and computed tomography (CT) scan, to evaluate organ involvement 3, 4
Treatment Approach
The treatment approach for lupus depends on the severity of the disease and the organs involved. The following are some of the key components: