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- So the approach to diagnosing systemic lupus is
complicated in the sense that you need to look
at the entire picture of a patient's presentation
and their laboratory workup.
The two go together.
You can't really make a diagnosis just based
on the clinical presentation
if the laboratories don't fit.
There are many reasons why somebody may lose hair
and many reasons why somebody may develop
a rash that was triggered by sunlight.
There are many things that can cause
a presentation similar to lupus,
and that's what makes the diagnosis a challenge always.
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The most common misconception in lupus is that
the diagnosis can be made just based
on an antibody called ANA
or antinuclear antibody.
This is a screening test for lupus.
It's commonly done in the outpatient setting.
Many patients believe they have the disease
just based on the ANA.
About 1/3 of healthy adults in the United States
have a positive antinuclear antibody.
The presence of this test alone does not mean
that you have a systemic autoimmune disease.
So having a positive ANA alone is never
equivalent to a diagnosis of systemic lupus.
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The markers that patients are often concerned about is
having positive autoantibodies
like double-stranded DNA and low complements
or having low blood counts.
Even though these are markers of low disease activity,
they are not targeted by treatment.
So a doctor may not be able to give you
a medication to get rid of these.
If they are not accompanied by a clinical sign
that your disease is active,
meaning swollen joints, fevers,
protein in the urine, and so on,
alone those do not require changes in management.
There are many reasons why the commonly accepted markers
in other inflammatory diseases like CRP
or sedimentation rate are elevated in lupus.
They may be elevated because you're having an infection.
It may be elevated because a patient is overweight or obese.
So again, all of them need to be taken in context.
So there's no gold standard laboratory marker
that will tell us that we must change treatment
unless it's a sign of kidney activity.
But in general, the commonly accepted markers
of disease activity like CRPS are always needed
to be taken in context,
and alone are not a target of treatment.
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The diagnosis of lupus is additive,
so I may not be able to see
everything that the patient's experienced before.
They may have had rashes in the past
so it's important to understand
what kind of rashes they were
whether they're rashes that go away within an hour
or is this a facial rash that occurs when they're emotional
or they eat spicy food.
Many times these facial rashes are interpreters
as being the so-called malar rash in lupus
which is a inflammatory rash
occasionally triggered by sun that lasts for days,
not really related to emotions or spicy food or so
because that is mostly rosacea.
Painful joints versus swelling,
sometimes patients complain of a lot of pain in their hands
or in different joints of their body
and it's triggered by activity.
They do things at home, they lift something heavy,
they develop pain, they rest, it goes away.
It's not as a typical mechanical pain
that is never a sign of lupus.
Lupus causes stiffness, pain at rest.
So, all the symptoms need to be questioned further.
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