Table of ContentsView AllTable of ContentsChallengesDiagnostic CriteriaAutoantibody TestsBlood TestsTissue BiopsyImaging StudiesDifferential DiagnosisNext in Lupus GuideLupus Treatment Options
Table of ContentsView All
View All
Table of Contents
Challenges
Diagnostic Criteria
Autoantibody Tests
Blood Tests
Tissue Biopsy
Imaging Studies
Differential Diagnosis
Next in Lupus Guide
Systemic lupus erythematosus(SLE), otherwise known as lupus. can be difficult to diagnose.Symptomscan follow tricky patterns, be mild or severe, or overlap with symptoms of other diseases.
A diagnosis of lupus can be made based on a physical exam, a review of your medical history, blood tests, and imaging studies like an MRI or ultrasound. To confirm the diagnosis, all other possible causes of your symptoms must be excluded.
Because of the complexity of diagnosis, some people with lupus can go months or years before a definitive diagnosis is received.
This article explains how lupus is diagnosed, including the diagnostic criteria, the tests involved in the investigation, and the diseases investigated as part of thedifferential diagnosis(made after ruling out other causes).
Challenges Diagnosing Lupus
There are many things that can complicate alupusdiagnosis. Chief among them is the fact that lupus is not one disease but an array of different subtypes, each with its distinctive causes and characteristics.
The main challenges of diagnosing lupus include:
Early Signs of Lupus in Females
There is no single blood or imaging test to definitively diagnose lupus. Because it can mimic other diseases, including otherautoimmune diseaseslike rheumatoid arthritis, it’s important to consult a specialist in autoimmune diseases known as arheumatologist.
The diagnosis of lupus involves different blood tests and imaging studies but is ultimately based on a set of criteria that a person must meet in order to be diagnosed.
If you have at least four of the following symptoms with no other causes—even if they appear just once or come and go—you may be diagnosed with lupus:
Under normal circumstances, the immune system will release immune proteins calledantibodiesthat “recognize” and attack disease-causing organisms (pathogens). Autoantibodies are immune proteins that mistakenly attack normal cells thinking they are pathogens.
There is no single autoantibody associated with lupus—some of the following occur with other autoimmune diseases. However, their presence can help confirm the diagnosis.
Antinuclear Antibody Test (ANA)
Theantinuclear antibody (ANA)test is one of the most sensitive tests to help diagnose lupus. All told, around 97% of people with lupus will have a positive ANA test result. A negative ANA test result means that lupus is unlikely.
With that said, other diseases or conditions can trigger an ANA positive result, including:
The ANA test not only measures the titer (concentration) of autoantibodies in a sample of blood but also the pattern with which they bind to cells. Certain titer values and patterns are more suggestive of lupus than others.
Note that 20% of otherwise healthy individuals can have a low titer positive ANA, so ANA should not be used as a screening test unless there is a high pre-test suspicion for lupus.
Additional Antibody Tests
Additional antibody tests may be used to support the diagnosis of lupus, including:
InterpretationsThe combination of a positive ANA and either anti-double-stranded DNA or anti-Smith antibodies is considered highly suggestive of lupus. However, not all people diagnosed with lupus have these autoantibodies, although they are much more specific for lupus than ANA.
Interpretations
The combination of a positive ANA and either anti-double-stranded DNA or anti-Smith antibodies is considered highly suggestive of lupus. However, not all people diagnosed with lupus have these autoantibodies, although they are much more specific for lupus than ANA.
There are many blood tests involved in the diagnosis of lupus. They are used mainly to diagnose features of the disease rather than the disease itself. They may also be used to exclude other causes.
Complete Blood Count (CBC)
Thecomplete blood count (CBC)is a panel of tests used to evaluate the composition of cells in a sample of blood.
With lupus, one of the primary aims is to determine whether autoantibodies are attacking organs that produce blood cells, causing numbers to drop.
These include blood tests like:
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Erythrocyte Sedimentation Rate
Theerythrocyte sedimentation rate (ESR)is a blood test that measures generalized inflammation in the body. Many diseases cause a high ESR, so the test is mainly used to differentiate inflammatory conditions like lupus from non-inflammatory ones likefibromyalgia.
A high ESR may point the healthcare provider in the direction of a lupus-associated condition, like lupus nephritis, for which additional tests may be needed.
C-reactive protein (CRP) is another marker of general inflammation. But unlike ESR, it doesn’t typically rise with lupus flares.
Urinalysis
Urinalysiscan detect abnormal substances in your urine. One of the goals with lupus is to check if there are any abnormalities associated with lupus nephritis, including proteinuria and hematuria.
Complement Levels
The complement system is the name of a group of blood proteins that help fight infection.Complement levels, as the name implies, measure the amount and/or activity of these proteins.
In some cases, your healthcare provider will want to do a biopsy of your skin, kidney, or other organs to see if you have signs of lupus. The tissue can be tested to check for signs of inflammation or tissue death (necrosis). Other tests can show if you have autoantibodies related to lupus.
Your healthcare provider may want to order imaging tests, particularly if you are having symptoms of heart, brain, or lung inflammation.
Options include:
Differential Diagnoses
Lupus is notoriously difficult to diagnose because its symptoms mimic those of other diseases. Because there is no single test to identify lupus, healthcare providers must investigate and exclude all other causes as part of the differential diagnosis.
These include:
Summary
Lupus can be difficult to diagnose because it can cause many different systems based on which organs are involved. There is no single lab test or imaging study able to diagnose lupus, so a lengthy diagnosis may be needed to determine if the symptoms meet the diagnostic criteria for lupus. All other possible causes must also be excluded.
The diagnosis of lupus typically involves a physical exam, a review of your medical history, autoantibody tests, various blood tests, and imaging studies.
Lupus Treatment Options
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Rees F, Doherty M, Grainge MJ, Lanyon P, Zhang W.The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies.Rheumatology (Oxford). 2017;56(11):1945-1961. doi:10.1093/rheumatology/kex260NYU Langone Health.Diagnosing systemic lupus erythematosus.Conti F, Ceccarelli F, Perricone C, et al.Systemic lupus erythematosus with and without anti-dsDNA antibodies: analysis from a large monocentric cohort.Mediators Inflamm. 2015;2015:328078. doi:10.1155/2015/328078Zanussi JT, Zhao J, Wei WQ, et al.Clinical diagnoses associated with a positive antinuclear antibody test in patients with and without autoimmune disease.BMC Rheumatol.2023;7(1):24. doi:10.1186/s41927-023-00349-4MedlinePlus.Complete blood count (CBC).Enocsson H, Karlsson J, Li HY, et al.The complex role of C-reactive protein in systemic lupus erythematosus.J Clin Med. 2021;10(24):5837. doi:10.3390/jcm10245837Gandino IJ, Scolnik M, Bertiller E, Scaglioni V, Catoggio LJ, Soriano ER.Complement levels and risk of organ involvement in patients with systemic lupus erythematosus. Lupus Sci Med. 2017;4(1):e000209. doi:10.1136/lupus-2017-000209Malik A, Hayat G, Kalia JS, Guzman MA.Idiopathic inflammatory myopathies: clinical approach and management.Front Neurol.2016;7:64. doi:10.3389/fneur.2016.00064Additional ReadingLam NC, Ghetu MV, Bieniek ML.Systemic Lupus Erythematosus: Primary Care Approach to Diagnosis and Management.American Family Physician.2016;94(4):284-94.Lupus Foundation of America.Lab tests for lupus.Lupus Foundation of America.How doctors diagnose lupus.Mayo Clinic Staff.Lupus. Mayo Clinic.Wallace DJ.Clinical manifestations and diagnosis of systemic lupus erythematosus in adults. UpToDate.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Rees F, Doherty M, Grainge MJ, Lanyon P, Zhang W.The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies.Rheumatology (Oxford). 2017;56(11):1945-1961. doi:10.1093/rheumatology/kex260NYU Langone Health.Diagnosing systemic lupus erythematosus.Conti F, Ceccarelli F, Perricone C, et al.Systemic lupus erythematosus with and without anti-dsDNA antibodies: analysis from a large monocentric cohort.Mediators Inflamm. 2015;2015:328078. doi:10.1155/2015/328078Zanussi JT, Zhao J, Wei WQ, et al.Clinical diagnoses associated with a positive antinuclear antibody test in patients with and without autoimmune disease.BMC Rheumatol.2023;7(1):24. doi:10.1186/s41927-023-00349-4MedlinePlus.Complete blood count (CBC).Enocsson H, Karlsson J, Li HY, et al.The complex role of C-reactive protein in systemic lupus erythematosus.J Clin Med. 2021;10(24):5837. doi:10.3390/jcm10245837Gandino IJ, Scolnik M, Bertiller E, Scaglioni V, Catoggio LJ, Soriano ER.Complement levels and risk of organ involvement in patients with systemic lupus erythematosus. Lupus Sci Med. 2017;4(1):e000209. doi:10.1136/lupus-2017-000209Malik A, Hayat G, Kalia JS, Guzman MA.Idiopathic inflammatory myopathies: clinical approach and management.Front Neurol.2016;7:64. doi:10.3389/fneur.2016.00064Additional ReadingLam NC, Ghetu MV, Bieniek ML.Systemic Lupus Erythematosus: Primary Care Approach to Diagnosis and Management.American Family Physician.2016;94(4):284-94.Lupus Foundation of America.Lab tests for lupus.Lupus Foundation of America.How doctors diagnose lupus.Mayo Clinic Staff.Lupus. Mayo Clinic.Wallace DJ.Clinical manifestations and diagnosis of systemic lupus erythematosus in adults. UpToDate.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Rees F, Doherty M, Grainge MJ, Lanyon P, Zhang W.The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies.Rheumatology (Oxford). 2017;56(11):1945-1961. doi:10.1093/rheumatology/kex260NYU Langone Health.Diagnosing systemic lupus erythematosus.Conti F, Ceccarelli F, Perricone C, et al.Systemic lupus erythematosus with and without anti-dsDNA antibodies: analysis from a large monocentric cohort.Mediators Inflamm. 2015;2015:328078. doi:10.1155/2015/328078Zanussi JT, Zhao J, Wei WQ, et al.Clinical diagnoses associated with a positive antinuclear antibody test in patients with and without autoimmune disease.BMC Rheumatol.2023;7(1):24. doi:10.1186/s41927-023-00349-4MedlinePlus.Complete blood count (CBC).Enocsson H, Karlsson J, Li HY, et al.The complex role of C-reactive protein in systemic lupus erythematosus.J Clin Med. 2021;10(24):5837. doi:10.3390/jcm10245837Gandino IJ, Scolnik M, Bertiller E, Scaglioni V, Catoggio LJ, Soriano ER.Complement levels and risk of organ involvement in patients with systemic lupus erythematosus. Lupus Sci Med. 2017;4(1):e000209. doi:10.1136/lupus-2017-000209Malik A, Hayat G, Kalia JS, Guzman MA.Idiopathic inflammatory myopathies: clinical approach and management.Front Neurol.2016;7:64. doi:10.3389/fneur.2016.00064
Rees F, Doherty M, Grainge MJ, Lanyon P, Zhang W.The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies.Rheumatology (Oxford). 2017;56(11):1945-1961. doi:10.1093/rheumatology/kex260
NYU Langone Health.Diagnosing systemic lupus erythematosus.
Conti F, Ceccarelli F, Perricone C, et al.Systemic lupus erythematosus with and without anti-dsDNA antibodies: analysis from a large monocentric cohort.Mediators Inflamm. 2015;2015:328078. doi:10.1155/2015/328078
Zanussi JT, Zhao J, Wei WQ, et al.Clinical diagnoses associated with a positive antinuclear antibody test in patients with and without autoimmune disease.BMC Rheumatol.2023;7(1):24. doi:10.1186/s41927-023-00349-4
MedlinePlus.Complete blood count (CBC).
Enocsson H, Karlsson J, Li HY, et al.The complex role of C-reactive protein in systemic lupus erythematosus.J Clin Med. 2021;10(24):5837. doi:10.3390/jcm10245837
Gandino IJ, Scolnik M, Bertiller E, Scaglioni V, Catoggio LJ, Soriano ER.Complement levels and risk of organ involvement in patients with systemic lupus erythematosus. Lupus Sci Med. 2017;4(1):e000209. doi:10.1136/lupus-2017-000209
Malik A, Hayat G, Kalia JS, Guzman MA.Idiopathic inflammatory myopathies: clinical approach and management.Front Neurol.2016;7:64. doi:10.3389/fneur.2016.00064
Lam NC, Ghetu MV, Bieniek ML.Systemic Lupus Erythematosus: Primary Care Approach to Diagnosis and Management.American Family Physician.2016;94(4):284-94.Lupus Foundation of America.Lab tests for lupus.Lupus Foundation of America.How doctors diagnose lupus.Mayo Clinic Staff.Lupus. Mayo Clinic.Wallace DJ.Clinical manifestations and diagnosis of systemic lupus erythematosus in adults. UpToDate.
Lam NC, Ghetu MV, Bieniek ML.Systemic Lupus Erythematosus: Primary Care Approach to Diagnosis and Management.American Family Physician.2016;94(4):284-94.
Lupus Foundation of America.Lab tests for lupus.
Lupus Foundation of America.How doctors diagnose lupus.
Mayo Clinic Staff.Lupus. Mayo Clinic.
Wallace DJ.Clinical manifestations and diagnosis of systemic lupus erythematosus in adults. UpToDate.
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