Hearing the diagnosis for the first time can make your world stand still or can make your head spin. What does this mean? How do I tell my family? Why is this happening to me?
By the time your doctors have a conclusive diagnosis they have already learned many things about your health and lifestyle. Their recommendations will help you with the “next steps” in managing lupus. The good news is now you can start treating the disease and not just reacting to the symptoms.
The onset of lupus may be acute, resembling an infectious process, or it may be a progression of vague symptoms over several years. As a result, diagnosing SLE is often a challenge. A consistent, thorough medical examination by a doctor familiar with lupus is essential to an accurate diagnosis. This must include a complete medical history and physical examination, laboratory tests, and a period of observation (possibly years). The doctor, nurse, or other health professional assessing a patient for lupus must keep an open mind about the varied and seemingly unrelated symptoms that the patient may describe. For example, a careful medical history may show that sun exposure, use of certain drugs, viral disease, stress, or pregnancy aggravates symptoms, providing a vital diagnostic clue.
No single laboratory test can definitely prove or disprove SLE. Lupus is usually easy to diagnose when the individual has many of the more characteristic symptoms and signs, but is made more difficult if none or only a few are present. Laboratory tests are usually conducted to help confirm or reject the diagnosis. These tests may include a blood count (CBC), looking for low number of white blood cells, red blood cells, and/or platelets. The urine is examined for protein and red/white blood cells. Blood tests may be done to measure kidney function. A variety of laboratory tests, X rays, and other diagnostic tools are used to rule out other pathologic conditions and to determine the involvement of specific organs. It is important to note, however, that any single test may not be sensitive enough to reflect the intensity of the patient’s symptoms or the extent of the disease’s manifestations.
The American College of Rheumatology (ACR), an organization of doctors and associated health professionals who specialize in arthritis and related diseases of the bones, joints, and muscles, has developed and refined a set of diagnostic criteria. If at least 4 of the 11 criteria develop at one time or individually over any period of observation, then the patient is likely to have SLE. However, a diagnosis of SLE can be made in a patient having fewer than four of these symptoms.
ACR Criteria for Diagnosing SLE
- Malar rash
- Discoid rash
- Oral ulcers
- Serositis (pleuritis or pericarditis)
- Renal disorder (persistent proteinuria or cellular casts)
- Neurological disorder (seizures or psychosis)
- Hematologic disorder (anemia, leukopenia or lymphopenia on two or more occasions, thrombocytopenia)
- Immunologic disorder (positive LE cell preparation, abnormal anti-DNA or anti-Sm values, false-positive VDRL syphilis test)
- Abnormal ANA titer
Source: Lupus Alliance of America, National Institute of Health