Clinical Immunology focuses on the immune system’s health. Learn about the diagnosis and treatment of allergies, autoimmune diseases, and immunodeficiencies.

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Lupus: Diagnosis and Tests

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Diagnosing lupus is one of the most challenging tasks in medicine. There is no single “yes or no” test for the disease. Instead, diagnosis is a puzzle that requires assembling pieces from clinical history, physical examination, and a battery of laboratory tests. The process can take months or even years as symptoms evolve. Physicians rely on established classification criteria, such as those from the American College of Rheumatology (ACR) and EULAR, to navigate the complexities of this autoimmune condition.

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Urinalysis and Renal Function

IMMUNOLOGY

Given the high risk of lupus nephritis, evaluating kidney health is a standard part of the diagnostic workup.

  • Proteinuria: The presence of protein in the urine is a key sign of kidney damage.
  • Hematuria: Red blood cells in the urine indicate inflammation in the filtering units of the kidneys.
  • Cellular Casts: Clumps of cells found in urine microscopy that suggest active kidney disease.
  • Creatinine: Blood levels are measured to estimate the glomerular filtration rate (GFR), showing how well the kidneys are filtering waste.
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General Laboratory Evaluations

IMMUNOLOGY

Beyond autoantibodies, general blood and urine tests reveal how the disease is affecting the body’s systems.

  • Complete Blood Count (CBC): Checks for anemia (low red blood cells), leukopenia (low white blood cells), and thrombocytopenia (low platelets), which are common in lupus.
  • Erythrocyte Sedimentation Rate (ESR): Measures how fast red blood cells settle; a speedier rate indicates inflammation.
  • C-Reactive Protein (CRP): A protein produced by the liver that rises when there is inflammation throughout the body.
  • Complement Levels (C3 and C4): Proteins that are part of the immune system; low levels suggest they are being used up by active inflammation.

The Antinuclear Antibody (ANA) Test

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The Primary Screening Tool

The ANA test is the entry point for lupus diagnosis. It detects antibodies that target the cell nucleus.

  • Sensitivity: Almost all patients with active lupus (over 97 percent) test positive for ANA.
  • Specificity Issues: A positive ANA does not automatically mean lupus. It can be seen in other autoimmune diseases, infections, and even in healthy individuals.
  • Titer Levels: High titers (levels) of ANA are more suggestive of autoimmune disease than low titers.
  • Patterns: The pattern of fluorescence seen under the microscope (e.g., speckled, homogeneous) can provide clues to the type of disease.

Secondary Autoantibody Panels

If the ANA is positive, more specific tests are ordered to confirm the diagnosis and assess organ risk.

  • Anti-dsDNA: Antibodies against double-stranded DNA are particular to lupus and often correlate with kidney inflammation.
  • Anti-Sm (Smith): An antibody targeting specific proteins in the nucleus; highly specific to lupus but found in fewer patients.
  • Anti-Ro/SSA and Anti-La/SSB: Associated with photosensitivity, subacute cutaneous lupus, and neonatal lupus risk.
  • Antiphospholipid Antibodies: Checked to assess the risk of blood clots and pregnancy complications.

Biopsy Procedures

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When non-invasive tests are inconclusive or when organ involvement needs precise staging, a biopsy is performed.

  • Skin Biopsy: A small sample of skin is taken from a rash to look for characteristic microscopic changes and immune deposits (Lupus Band Test).
  • Kidney Biopsy: The gold standard for diagnosing lupus nephritis. It determines the class of nephritis (I-VI) and guides the aggressiveness of treatment.
  • Procedure: Usually done with a needle under ultrasound guidance.
  • Utility: Helps distinguish between active inflammation (which can be treated) and permanent scarring (which cannot).

Imaging Studies

Imaging helps evaluate complications in organs that cannot be easily biopsied or seen.

  • Chest X-ray: To check for fluid around the lungs (pleural effusion) or inflammation of the lungs (pneumonitis).
  • Echocardiogram: An ultrasound of the heart to look for fluid around the heart (pericarditis) or valve abnormalities.
  • MRI and CT Scans: Used to investigate neurological symptoms (brain MRI) or abdominal pain.
  • Joint Ultrasound: Can detect synovitis (inflammation of the joint lining) even when swelling is not noticeable.

Diagnostic Criteria (ACR/EULAR)

Rheumatologists use a scoring system to standardize the diagnosis. A patient must meet a certain threshold of points derived from clinical and laboratory domains.

  • Entry Criterion: A positive ANA test is usually required to enter the classification algorithm.
  • Clinical Domains: Points are assigned for symptoms like fever, skin rashes, arthritis, and neurological issues.
  • Immunologic Domains: Points are assigned for specific antibodies and low complement levels.
  • Weighting: Certain features, like biopsy-proven kidney inflammation, carry more weight than others.

Differential Diagnosis

The diagnostic process involves rigorously ruling out other conditions that mimic lupus.

  • Infections: Viral illnesses like Parvovirus B19 or Hepatitis C can cause joint pain and rashes.
  • Other Autoimmune Diseases: Rheumatoid arthritis, Sjogren’s syndrome, and systemic sclerosis share many features.
  • Fibromyalgia: Causes chronic pain and fatigue, but is not an autoimmune inflammatory condition.
  • Malignancies: Certain blood cancers can present with fever, fatigue, and low blood counts.

Why Choose Liv Hospital

At Liv Hospital, we employ state-of-the-art diagnostic technology to solve the lupus puzzle. Our immunology laboratories utilize high-sensitivity assays to detect autoantibodies with precision, minimizing false positives and negatives. We offer advanced imaging and minimally invasive biopsy techniques performed by interventional specialists to stage organ involvement accurately. Our team carefully synthesizes this data to ensure your diagnosis is accurate and comprehensive. We believe that a precise diagnosis is the foundation of effective treatment, and we leave no stone unturned in understanding your unique condition.

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FREQUENTLY ASKED QUESTIONS

Why is the ANA test not enough to diagnose lupus?

Because a positive ANA can be found in healthy people or those with other infections, it indicates an active immune system but doesn’t specify lupus on its own.

It is generally safe but carries a small risk of bleeding. The information it provides is often critical for saving kidney function.

During active disease, you might need tests every month. When stable, tests are usually done every 3 to 6 months.

It is possible, but scarce (called ANA-negative lupus). In these cases, other specific antibodies, such as Anti-Ro/SSA, are usually present.

Active lupus shows high inflammation markers (ESR, CRP), low complement levels, and high DNA antibodies. Inactive lupus shows normal or stable levels.

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