From the Guidelines
Monitoring lupus requires regular laboratory tests, including complete blood count (CBC), comprehensive metabolic panel, urinalysis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-double stranded DNA (anti-dsDNA) antibodies, and complement levels (C3, C4), to assess disease activity and medication effects, as recommended by the European League Against Rheumatism 1. The frequency of testing varies based on disease activity, medication regimen, and organ involvement, but most stable patients require testing every 3-6 months, with more frequent monitoring during flares or medication adjustments 1. Some key laboratory tests to monitor in lupus patients include:
- Complete blood count (CBC) to monitor for anemia, leukopenia, and thrombocytopenia
- Comprehensive metabolic panel to evaluate kidney and liver function
- Urinalysis to detect protein or blood in urine, early signs of lupus nephritis
- ESR and CRP to track disease activity
- Anti-dsDNA antibodies and complement levels (C3, C4) to correlate with disease activity Additional monitoring is needed for patients on specific medications, such as:
- Hydroxychloroquine: regular eye exams
- Immunosuppressants (e.g. azathioprine, mycophenolate mofetil, methotrexate): liver function tests and blood counts
- Biologics: tuberculosis screening before initiation It is also important to note that a quantitative assay testing anti-dsDNA should be used to monitor disease activity, preferably with the same method used in diagnosis and performed by the same laboratory 1. Furthermore, anti-dsDNA and complement levels should be measured in patient follow-up, even if they were negative (anti-dsDNA) / within the reference range (complement) in previous monitoring visits 1. Overall, regular laboratory testing is crucial to monitor disease activity, adjust treatment, and prevent complications in lupus patients.
From the Research
Labs to Monitor Lupus
To monitor lupus, particularly lupus nephritis, several laboratory tests can be utilized:
- Urine analysis to detect proteinuria, which is a common indicator of renal involvement in lupus patients 2
- Complete blood picture to assess overall blood cell counts and detect any abnormalities
- Liver function tests to evaluate the liver's condition, as lupus can affect various organs
- Kidney function tests, including albumin/creatinine ratio, to assess the kidneys' functioning and detect any signs of nephritis
- Antinuclear antibody (ANA) test, as most lupus patients test positive for ANA
- Anti-double stranded DNA (anti-dsDNA) antibody test, which can help assess disease activity and is often associated with lupus nephritis 2
- Complement levels, including C3 and C4, which can be decreased in active lupus, particularly in those with nephritis 2
- Anti-C1q antibodies, which have been found to correlate with disease activity and may serve as a useful marker for active lupus, especially with nephritis 2