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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Diagnosing Systemic Lupus Erythematosus is a complex clinical puzzle. There is no single test that provides a simple yes or no answer. Instead, Liv Hospital specialists rely on a combination of clinical observations, patient history, and a battery of sophisticated laboratory tests. Rheumatologists typically use classification criteria, such as those established by the EULAR or ACR, to help guide diagnosis. These criteria weigh various clinical and immunological features to determine if a patient falls within the lupus spectrum.
The Antinuclear Antibody or ANA test is the primary screening tool for lupus. It detects antibodies that target the nucleus of the body’s cells.
Antibodies to double-stranded DNA are highly specific for SLE. They are rarely found in people who do not have lupus. Furthermore, the levels of Anti dsDNA often fluctuate with disease activity. A rising titer can predict an impending flare, particularly involving the kidneys.
Antibodies to the Smith nuclear antigen are also highly specific for lupus. While they are less sensitive and found in only about 30 percent of patients, their presence is virtually diagnostic for the disease. Unlike anti-dsDNA, anti-Smith levels tend to remain stable and do not correlate with disease flares.
These antibodies are found in lupus but also in Sjögren syndrome. Their presence is important for counseling women of childbearing age, as they are associated with a risk of neonatal lupus and congenital heart block in the fetus. They are also associated with photosensitive skin rashes.
The complement system is a group of proteins that work with the immune system to clear pathogens. In active lupus, immune complexes form and consume these complement proteins.
Given the risk of silent kidney damage, urine tests are mandatory.
A CBC is performed to detect hematological issues.
Erythrocyte Sedimentation Rate and C-Reactive Protein are general markers of inflammation. In lupus, the ESR is frequently elevated during flares. Interestingly, the CRP may remain normal or only slightly elevated unless there is serositis (inflammation of the lung or heart lining) or a bacterial infection. A very high CRP in a lupus patient often prompts a search for an infection rather than just attributing it to the lupus itself.
Since blood clots are a major risk, testing for antiphospholipid antibodies is routine.
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It stands for Antinuclear Antibody test. It screens for antibodies that attack the nucleus of cells and is positive in almost all lupus patients.
It is extremely rare to have systemic lupus with a negative ANA test. Such cases exist, but usually involve specific antibody subsets like Anti-Ro.
Low levels of C3 and C4 indicate that the disease is active and the immune system is consuming these proteins to fuel inflammation
It is done under local anesthesia. There is some pressure and discomfort, but it is generally well tolerated and essential for guiding treatment.
This antibody is specific to lupus. High levels often indicate active disease, especially in the kidneys, helping doctors predict and treat flares
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