From the Guidelines
Laboratory monitoring for Systemic Lupus Erythematosus (SLE) management should include complete blood count (CBC), comprehensive metabolic panel (CMP), urinalysis, complement levels (C3 and C4), and anti-dsDNA antibodies, as recommended by the European League Against Rheumatism 1 and expert panels 2, 3, 4, 5, 6.
The following laboratory tests are essential for SLE management:
- CBC to detect cytopenias common in lupus
- CMP to assess kidney and liver function, particularly important when using medications like hydroxychloroquine, methotrexate, or mycophenolate mofetil
- Urinalysis to screen for kidney involvement, a serious complication of lupus
- Complement levels (C3 and C4) and anti-dsDNA antibodies as disease activity markers, with low complement and high anti-dsDNA often indicating active disease Additional monitoring should include:
- Lipid panels and bone density scans due to increased cardiovascular risk and potential steroid-induced osteoporosis
- Drug-specific monitoring for patients on specific medications, such as:
- Hydroxychloroquine: baseline and annual eye exams
- Methotrexate: liver function tests every 4-8 weeks
- Biologics like belimumab: infection screening Regular monitoring allows for early detection of disease flares and medication side effects, enabling timely intervention to prevent organ damage and optimize treatment outcomes, as emphasized by recent studies 2, 3, 4, 5, 6.
It is also important to note that the use of anti-dsDNA autoantibodies in the diagnosis and follow-up of SLE is a topic of ongoing discussion, with expert panels recommending a double-screening strategy using a last-generation SPA and the CLIFT as the confirmation test 3. Furthermore, the interpretation of laboratory test results should be harmonized across assays, and the selection of the most adequate assay and appropriate interpretation of results are crucial for accurate diagnosis and monitoring of SLE 5.
From the Research
Laboratory Tests for Systemic Lupus Erythematosus (SLE) Management
The following laboratory tests are used in the management of SLE:
- C3/C4 levels 7
- Anti-dsDNA autoantibodies 7, 8, 9, 10, 11
- Chemistry tests 7
- Urinalysis 7
- Complete blood count (CBC) 7
- Anti-chromatin antibodies 8
- Anti-nucleosome antibodies 9
- Anti-C1q antibodies 9
- Anti-histone antibodies 9
Specificity of Anti-dsDNA Testing
The specificity of anti-dsDNA testing varies depending on the test method, with some methods showing higher specificity than others 10. The Crithidia luciliae indirect immunofluorescence test (CLIFT) and fluorescence enzyme immunoassay methods are likely to be ≥ 90% specific.
Monitoring of SLE Disease Activity
Laboratory tests such as anti-dsDNA, anti-chromatin, anti-nucleosome, anti-C1q, and anti-histone antibodies can be used to monitor SLE disease activity 8, 9. These tests can help predict flares and lupus nephritis, and can be used to assess the response to treatment.
Use of Laboratory Tests in Clinical Practice
The use of laboratory tests in the management of SLE can help guide treatment decisions and monitor disease activity 7, 8, 9, 10, 11. However, the results of these tests should be interpreted in the context of the individual patient's clinical presentation and medical history.