Is there a test for systemic lupus?

There isnít any testing for systemic lupus

 Why is systemic lupus so difficult to diagnose?

There are several reasons why systemic lupus is hard to diagnose which include:

        It is a multi-system disease, before this disease with multi systems can be diagnosed one needs lab reports and symptoms in several parts of the body to support the presence of a mulit-system disease.

        It is very difficult to diagnose due to the slow onset for development.  The symptoms tend to come and go and it takes time to accumulate enough to indicate the disease.

        This is the great imitator because it mimics so many other diseases and conditions.

        There has not been a single diagnostic test for lupus, which makes diagnosing the disease extremely difficult.

How is systemic lupus diagnosed?

Information is gathered from several sources including past medical history, lab tests and current symptoms.  A list of 11 criteria is used to diagnose SLE.  That person needs to have at least 4 out of the 11 criteria before the diagnosis can be pinpointed.

When dealing with the 11 criteria 7 have to relate to symptoms, and 4 must deal with lab tests.  Systemic lupus uses the ANA test for screening.  95% of the people with systemic lupus are ANA positive.  If a person has an ANA that is negative and several symptoms for systemic lupus you are not in favor for having lupus in regards to the symptoms present. 

If on the other hand, the ANA comes back positive, that IS NOT proof of lupus. The positive ANA is only an indicator; it is not diagnostic. A positive ANA can be found in a number of illnesses and conditions including:

If the ANA is positive this is an indicator not a diagnosis of having lupus.  Having a positive ANA has been found in a number of illnesses and conditions including the following:

Rheumatoid arthritis, Sjogren's syndrome, Sclerodema.

      Infectious diseases include the following diseases mononucleosis, malaria, subacute bacterial endocarditis SBE.

Autoimmune diseases include autoimmune thyroid disease, and autoimmune liver disease.

Medications are also known to cause a positive ANA, only about 20% of the general population that test positive for ANA and can have none of the above mentioned symptoms to the illness.

The ANA reading is only an indicator not diagnostic and satisfies only one criterion and you need to satisfy an additional 3 critieria.

Confusion About Diagnosis  

How can a person be sure that they have lupus or not, even if they have all the symptoms and their doctor doesnít think they have lupus or not?

The 11 criteria which is used to help diagnose lupus consist of symptoms and lab testing specific for SLE.  Please do not confuse the 11 criteria for the common symptoms of systemic lupus since the symptoms could be due to a number of other conditions and illnesses.

A physician may feel that if a person appears to have many of the symptoms of lupus they could believe that lupus is developing.  Then they can evaluate the patient and see if the criteria are met.  Remember you must have at least 4 out of the 11 to be diagnosed with systemic lupus.  An expert in diagnosing lupus would be a rheumatologist or a clinical immunologist.

If someone has lupus how can they be diagnosed at the onset instead of later with the disease? 

Lupus is a slow developing disease which evolves over time, if you are being seen by a doctor and you meet 1 or 2 criteria no still cannot be sure as to diagnose you with lupus.  They cannot predict if you will develop the disease to the point of diagnosis.

Lupus is variable when diagnosis is concerned, it could take weeks, months or years.  Some have even been up 10 years to develop symptoms that would indicate that one has lupus.  A Doctor may have a pretty good but they cannot be certain that one has SLE.  It is very important to note that if you have signs and symptoms and something new develops let your doctor know.

My doctor suspects I have lupus, but hasn't diagnosed me with it yet. I have a lot of joint pain in my hands and knees. Can anything be prescribed to give me some relief, or do I have to wait until I have a definite diagnosis before they can treat me?

Trial medications have been found to be helpful with some of the symptoms and one should discuss this with their doctor.

Border line positive lupus test means what?

The test is called ANA which is antinuclear antibody tests and all test have normal values.  If oneís test comes back at the upper limit of normal this is referred to borderline.  It will have more importance if other criteria are present.

I was told my ANA was positive, but I don't have lupus. My Doctor thinks I have a connective tissue disease. What does this mean?

I have a positive ANA, however no evidence of lupus but my doctor believeís I have a connective tissue disease.  What does this mean?

There are several symptoms of connective tissue disease which are joints, tendons, cartilage, collagen, and muscles of the skin.  It is not uncommon to have symptoms that indicative connective tissue disease and not enough of the symptoms to specify lupus.

I was told my ANA was negative, and I don't have lupus. Is it possible to have lupus with a negative ANA?

95% people with systemic lupus have a positive ANA, and only a small percent have a negative ANA.  Many have other antibodies that were detected in their blood.  An ANA can sometimes convert form positive to negative following administration of steroids.

What kind of Doctor can diagnose systemic lupus?

A specialist for systemic lupus diagnosis would be a rheumatoloist.  But your family physician can make a diagnosis if multiple criteria are met.

I do not meet the criteria for diagnosis of systemic lupus is there anyway I can slow down the development of the disease?

You cannot arrest the development of lupus, but you could help with your well being by considering the following:

    * Educating yourself as much as you can about lupus so if you develop further symptoms, you will recognize them and notify your doctor,

    * Eating a well balanced diet,

    * Managing stress more effectively, and

    * Take your doctorís advice  

I have a positive ANA with a lot of pain, I am being considered for fibromylagia instead of lupus.  Fibro being most common in women could explain the widespread pain, because having a positive ANA does not mean one has lupus.

Diagnosis  

Diagnostic criteria are made on the basis of the ACR which was established mainly for the use of its scientific research.  Patients may have lupus and never met the criteria in full.

The mainstay testing for lupus involves the Anti-nuclear antibody testing and the anti-extractable nuclear antigen.  Antibodies involved are the antiphospholipids which occur often in SLE and can predispose you for thrombosis.  Other antibodies are the anti-smith and the anti-dsDNA.

LE which is lupus erythematosus used cell testing for diagnosis, but the LE cells are only found in 50-75% of the SLE patients.  The LE cell test is only being performed rarely.

The following are the 11 criteria involved with diagnosis of SLE:

1.     Rash on Cheeks

2.     Discoid Lupus

3.     Exposure to light

4.      Oral and nasal ulcers

5.     Arthritis

6.     Kidney disorders

7.     Neurological disorders

8.      Serositis

9.      Blood Disorders

10.    10. Anti-nuclear antibody test positive, very sensitive (98%) but non specific.

11. Immunologic disorders

Common misdiagnoses  

Porphyria  

Porphyrias are complex genetic disorders that share many symptoms with lupus, but impact the enzymes responsible for building heme, a component needed in heme proteins. Porphyrias are ecogenic disorders requiring both environmental Porphyias are complex genetic disorders which share several of the lupus symptoms.  Porphyias are ecogenic disorders as well requiring both environmental and genetic backgrounds.  The are sensitive to light and have been associated with transient or permanent production of autoantibodies.  In all lupus cases porphyias should be taken seriously when patients are in a medical crisis.  Underlying porphyria is suspected when they are photosensitive and are said to have drug induced lupus.  Patients with both lupus and porphyria should avoid porphyrinogenic drugs and hormone preparations.

Patients that have acute hepatic porphyries has been detected in lupus patients with severe life threatening lupus complications as neurolupus.  The symptoms involvedinclude seizures, psychosis, peripherial neropathy.  Several other lupus symptoms have been associated with porphyries which are pancreatitis, and pericarditis.  Porphrin testing should be performed on urine, stool/bile and blood so you can detect all types of porphyries.  Repeated test should be done on suspicious cases.

Common dual diagnoses  

SLE is sometimes diagnosed in conjunction with other conditions, including Rheumatoid Arthritis and Fibromyalgia.  

 

 

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