Diagnosis of Lupus

Since Lupus often first shows itself disguised with a variety of different symptoms, often masquerading as sign of other diseases, patients tend to visit a doctor specializing in the treatment of whatever symptom of the disease is currently bothering them. Consequently, it can be a frustrating experience for a person with Lupus to get a definitive diagnosis of Lupus when they first become ill.

Often times, one of the first signs of Lupus may show up as signs of arthritis such as red, hot, painful, stiff or swollen joints, deformed joints such as knees, fingers or toes, feeling a sensation of grinding in the joints like bone on bone, or a general loss of mobility in the joints. This will often result in the patient seeking out a rheumatologist as the first physician to be consulted. The physician will check for joint inflammation and mobility problems as well internal body inflammation in the patient’s organs such as kidneys, heart, lungs or other internal organs such as the kidneys, heart, lungs and other organs.

Since there is no official medical facility specializing in the diagnosis, care and treatment of Lupus in the United States, it is advisable to locate a physician who has a practice that is affiliated with an accredited medical school, college or teaching hospital. It is a difficult and time consuming process to test for and confirm that a patient in fact has Lupus and not some other disorder. Lupus is a disease which imitates a variety of illnesses. The symptoms often mimic other diseases, can come and go and rapidly change. The physician will make a preliminary Lupus diagnosis by:

1. Carefully observing, charting and reviewing the patient’s presenting symptoms

2. Providing a comprehensive physical exam and appropriate blood tests

3. Eliciting a comprehensive medical history not only on the patient but also assuring that they get a thorough medical history on the patient’s blood related relatives such as grandparents, parents, siblings, aunts, uncles and cousins. As previously indicated, it is very difficult to diagnose Lupus, mainly due to the fact that a variety of other medical conditions look like Lupus or coexist alongside Lupus. These factors necessitate that the physician order a series of tests to diagnose or eliminate the potential presence of other conditions. The most common tests utilized in identifying Lupus include:

  • A Complete Blood Count: Usually the physician will order a “blood panel” also known as a “complete blood count” (CBC).  The CBC measures the number of red and white blood cells, the percentage of red cells in the blood, and the amount of hemoglobin platelets, and serum in the blood. Often when a patient has Lupus, their CBC counts may test out lower than normal. There are many other types of blood tests that check for various levels of proteins in blood that are not antibodies. These protein tests can ascertain the presence of an inflammation in the body
  • Urine Tests: Lupus is known to attack the kidneys without any evidence of kidney problems. The physician will order urine testing to check whether the kidneys are filtering cell particles, proteins and waste particles properly.
  • Antibody Tests:  When Lupus is present, the body produces antibodies which attack the body’s own cells and tissues by attaching them selves to the center of a cell and damaging it. While there are numerous antibody tests that check for these antibodies when diagnosing Lupus, the Antinuclear Antibodies test (ANA) is the one most frequently utilized. The ANA is ordered when there is a suspicion of other body organs or major systems being involved. There are numerous other antibody tests which the physician may order based on the patient’s symptoms.
  • C-Reactive Protein Test (CRP): is a protein substance produced by the liver which can indicate that the patient may have an inflammation when it is found in high levels.
  • Erythrocyte Sedimentation Rate (ESR or “Sed” Rate: This is another test which measures the amount of a protein that makes the red blood cells clump together. The sed rate can be high due to other infections, but is usually quite high in people with active Lupus.
  • Blood Clotting Time Tests: Blood clotting tests can tell the physician of possible dangers related to whether the blood clots too quickly or too slowly.  Clotting too quickly can form a blood clot or thrombosis potentially causing a stroke, while blood clotting too slowly can create a risk for too much blood loss during surgery or from a cut.
  • Tissue Biopsies: If Lupus is suspected the physician may order a biopsy which consists of removing a small sample of a portion of skin or kidney tissue, to determine any damage to the tissue from the disease. The biopsy can also determine if there are other antibodies that are caused by Lupus.

Final Diagnosis:  SLE is one of the most difficult diseases to diagnose due to the fact that there is no single diagnostic test for Lupus. Many patients have tested positive for Lupus and may NOT have the disease diagnosed for a number of reasons. SLE is a disease which affects multiple systems and organs in the body. Before a disease that affects such a multitude of parts of the body can be definitively diagnosed, the symptoms must be present in those various parts of the body backed by specific lab work that indicates its presence. Because the onset of the disease does not come on rapidly and changes over a period of time, it is difficult to diagnose. Different signs of the disease may present them selves periodically. As previously mentioned, Lupus is often called “The Great Imitator” because it initially can appear as other diseases and conditions and takes a significant amount of time to recognize and test for a sufficient amount of the symptoms to make a diagnosis