Lupus

[OperaMBA]

Hey all,

What are some of the key tests for lupus?   I was looking at the symptoms last night, and I have almost all of them (go figure, yeah right).

The one, quite odd thing is that I have had an oval-shaped rash about the size of a nickel that has appeared, then disappeared 3 times since the middle of August.   It is quite scaly with scales the size of BB's.   The rash is partially on the nose, just above the bridge.

Anyway, I was wondering what my PCP has done to consider Lupus during this whole whacky ride.

Richard
OperaMBA

[wishforchange]

Sorry for speed of response, just was about to log off and get on with work.

Where do you live?

I am about to have a full screening for lupus in a specialised centre in a  few weeks so remind me if you like and I'll tell you what they did.  A very common symptom is a worsening of all problems in heat or sunny weather.  Vascular issues are common.  Butterfly malar rash across both cheeks is another telltale sign.

ANA blood tests are positive in most SLE patients but not always.  Are you talking about discoid lupus (skin only affected). or systemic?  A history of eg Raynauds syndrome (google it?) is another pointer.  ESR, a test for inflammation in the body is often raised, but again not always.  My ESR was normal yet on an MRI my hip and leg muscles were very inflamed.  With SLE rheumatoid arthritis is commonly a problem.

Also don't know your age but sometimes SLE symptoms present in early life apparently can recede as you get older, so I was told by a lupus nurse specialist.  Really if you think this is the problem, apologies don't know your history, look into finding a specialist in your area.  Most general doctors don't know enough about the condition and rely heavily on blood tests, which may miss the diagnosis as it is sometimes not evident in blood results.

Related condition is sjorgens syndrome, however it's spelt.  Causes dryness of eyes and salivary glands and also joint problems.  The presence of dryness of eyes can easily be tested by a doctor by putting blotting paper against the eye which should become damp in normal eyes.

You probably know but Lupus is an auto-immune condition of connective tissue, and at its worst can kill  (rarely, do not panic!), at its mildest is more of a cosmetic problem (mild discoid version), with a whole range of variations in between.  If that came out all wrong blame it on me being in a rush.

Like MS, lupus can be hard to diagnose and has many mimics.  I'll know far more when I've had my investigations, so remind me if you want to know how they went.

best

wish

[Deb61]

There is such a thing as drug-induced lupus.  Have you considered that?  Certain drugs that treat hypertension, heart disease, thyroid disease, & antibiotics have been know to induce lupus especially:  procainamide (Pronestyl); hydralazine (Apresoline); and quinidine (Quinaglute).  

I once thought that I had lupus because I had many of the symptoms.  I even had some positive tests for lupus.  However, the ANA test was never high in titer.  To have active lupus, the ANA is usually high.  

There is no one test to see if you have lupus.  It is a clinical diagnosis, much like MS is.  I thought I met the criteria, as outlined by slightlybroken, too.  However, some of the lupus-like symptoms settled down for me, and the more neurological ones revved up.  

Here are some tests that may contribute to a serious concern for having lupus if positive:

CBC--which reveals anemia, thrombocytopenia, leukopenia, or lymphocytopenia.
Anti-DNA antibodies
LE prep
Urinalysis- reveals protein in the blood (kidney disease)
Antibodies to SM
A false-positive serologic test for syphilis
ANA-
ESR- determines inflammatory disease
Blood chemistry screen-  for creatinine levels, etc.
BUN- measures renal function
Anti-double-standed DNA antibodies
Anti-SSA/RO and ANTI-SSB/LA
Antiphospolipid antibodies
Serum Complement Levels- people with lupus tend to have lower than normal complements levels
RF- 20% of lupus patients test positive
Skin biopsy- of rashes
Bone density/X-rays to reveal inflammation--lupus generally does not cause joint damage (but can).  There is generally inflammation in joints.
Chest x-rays- lung problems
EKG- irregular heart beat/rhythm;
MRI/CAT scans- up to 50% of lupus patients have trouble in the CNS

Deb

[slightlybroken]

People with Lupus will get a "butterfly rash" across their nose and cheeks. They can also have a positive RA factor because Lupus does joint damage.

Wonka is correct that it is difficult to diagnose in the beginning of the disease and you do have to meet 4 out of 11. Your levels (blood levels) will flucuate (becoming normal then abnormal when the disease is active).

An ANA is a standard test for Lupus but will also come up positive for other diseases. A Anti-dsDNA blood test is a specific test for Lupus. It will only come up positive for this disease. In the health pages...look under "Common Blood Test You'll See During The Diagnosis Process" and there are several listing of Lupus related blood test there. Anytime it says autoimmune..it's refering to Lupus, Sjogrens etc...

This is the criteria:
The "Eleven Criteria"
1.Malar rash: butterfly-shaped rash across cheeks and nose
2.Discoid (skin) rash: raised red patches
3.Photosensitivity: skin rash as result of unusual reaction to sunlight
4.Mouth or nose ulcers: usually painless
5.Nonerosive Arthritis (bones around joints do not get destroyed): in 2 or more joints with tenderness, swelling, or effusion
6.Cardio-pulmonary involvement: inflammation of the lining around the heart (pericarditis) and/or lungs (pleuritis)
7.Neurologic disorder: seizures and/or psychosis
8.Renal (kidney) disorder: excessive protein in the urine, or cellular casts in the urine
9.Hematologic (blood) disorder: hemolytic anemia, low white blood cell count, or low platelet count
10.Immunologic disorder: antibodies to double stranded DNA, antibodies to Sm, or antibodies to cardiolipin
11.Antinuclear antibodies (ANA): positive test in absence of drugs known to induce it

[wonko]

Hi Richard,

From my limited knowledge, Lupus can also be very difficult to diagnose.  You can do some googling, but I think there are 11 criteria and at least 4 are required for a dx.

A major part of the testing is bloodwork, esp. the ANA test.  

If you think you need a full workup for Lupus, you should see a rheumie.

This is a short answer, but perhaps enough to get you started.