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Diagnosis
Because many lupus symptoms mimic other
illnesses, are sometimes vague
and may come and go, lupus can be difficult to diagnose. Diagnosis
is usually made by a careful review of a person's entiremedical
history coupled with an analysis of the results obtained in
routinelaboratory tests and some specialized tests related
to immune status. Currently, there is no single laboratory
test that can determine whether a person has lupus or not.
To assist the physician in the diagnosis of lupus, the American
Rheumatism Association issued a list of 11 symptoms or signs
that help distinguish lupusfrom other diseases (see Table
2). A person should have four or more of these symptoms to
suspectlupus. The symptoms do not all have to occur at the
same time.
TABLE
2. THE ELEVEN CRITERIA USED FOR
THE DIAGNOSIS OF LUPUS
| Criterion |
Definition |
| Malar
Rash |
Rash over the cheeks |
| Discoid
Rash |
Red raised patches |
| Photosensitivity |
Reaction to sunlight,
resulting in the development of or increase in skin
rash |
| Oral Ulcers |
Ulcers in the nose
or mouth, usually painless |
| Arthritis
|
Nonerosive arthritis
involving two or more peripheral joints (arthritis in
which the bones around the joints do not become destroyed) |
| Serositis
|
Pleuritis or pericarditis |
| Renal
Disorder |
Excessive protein
in the urine (greater than 0.5 gm/day or 3+ on test
sticks) and/or cellular casts (abnormal elements the
urine, derived from red and/or white cells and/or kidney
tubule cells) |
| Neurologic |
Seizures (convulsions)
and/or psychosis in the absence of drugs or metabolic
disturbances which are known to cause such effects |
Hematologic
Disorder |
Hemolytic anemia or
leukopenia (white blood count below 4,000 cells per
cubic millimeter) or lymphopenia (less than 1,500 lymphocytes
per cubic millimeter) or thrombocytopenia (less than
100,000 platelets per cubic millimeter). The leukopenia
and lymphopenia must be detected on two or more occasions.
The thrombocytopenia must be detected in the absence
of drugs known to induce it. |
Immunologic
Disorder |
Positive LE prep test,
positive anti-DNA test,
positive anti-Sm test or false positive syphilis
test (VDRL) |
|
Antinuclear
Antibody
|
Positive test for antinuclear
antibodies (ANA) in
the absence of drugs known to induce it
|
Adapted from: Tan, E.M., et. al. The
1982 Revised Criteria for the Classification of SLE. Arth
Rheum 25: 1271-1277.
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