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Tests and diagnosis

By Mayo Clinic staff

Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may vary over time and overlap with those of many other disorders. No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis.

Laboratory tests
Blood and urine tests may include:

  • Complete blood count. This test measures the number of red blood cells, white blood cells and platelets as well as the amount of hemoglobin, a protein in red blood cells. Results may indicate you have anemia, which commonly occurs in lupus. A low white blood cell or platelet count may occur in lupus as well.
  • Erythrocyte sedimentation rate. This blood test determines the rate at which red blood cells settle to the bottom of a tube in an hour. A faster than normal rate may indicate a systemic disease, such as lupus. The sedimentation rate isn't specific for any one disease. It may be elevated if you have lupus, another inflammatory condition, cancer or an infection.
  • Kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs.
  • Urinalysis. An examination of a sample of your urine may show an increased protein level or red blood cells in the urine, which may occur if lupus has affected your kidneys.
  • Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies — produced by your immune system — indicates a stimulated immune system. While most people with lupus have a positive ANA test, most people with a positive ANA do not have lupus. If you test positive for ANA, your doctor may advise more-specific antibody testing.

Imaging tests
If your doctor suspects that lupus is affecting your lungs or heart, he or she may suggest:

  • Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or inflammation in your lungs.
  • Echocardiogram. This test uses sound waves to produce real-time images of your beating heart. It can check for problems with your valves and other portions of your heart.

Biopsy
Lupus can harm your kidneys in many different ways and treatments can vary, depending on the type of damage that occurs. In some cases, it's necessary to test a small sample of kidney tissue to determine what the best treatment might be. The sample can be obtained with a needle, or through a small incision.

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References
  1. Handout on Health: Systemic lupus erythematosus. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Lupus/. Accessed Aug. 22, 2011.
  2. Crow MK. Systemic lupus erythematosus. In: Goldman L, et al. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/191371208-2/0/1492/0.html#. Accessed Aug. 22, 2011.
  3. Systemic lupus erythematosus. In: Ferri FF. Ferri's Clinical Advisor 2011: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-0-323-05610-6..C2009-0-38600-6--TOP&isbn=978-0-323-05610-6&about=true&uniqId=230100505-53. Accessed Aug. 22, 2011.
  4. Schur PH, et al. Diagnosis and differential diagnosis of systemic lupus erythematosus in adults. http://www.uptodate.com/home/index.html. Accessed Aug. 23, 2011.
  5. Hahn BH. Systemic lupus erythematosus. In: Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4. Accessed Aug. 23, 2011.
  6. Schur PH, et al. Overview of the therapy and prognosis of systemic lupus erythematosus in adults. http://www.uptodate.com/home/index.html. Accessed Aug. 23, 2011.
  7. Moder KG (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 25, 2011.
  8. Rohren CH (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 1, 2011.
  9. Falk RJ, et al. Indications for renal biopsy in patients with lupus nephritis. http://www.uptodate.com/home/index.html. Accessed Sept. 1, 2011.
  10. Whittier WL, et al. Indications for and complications of renal biopsy. http://www.uptodate.com/home/index.html. Accessed Sept. 1, 2011.
  11. Haija AJ, et al. The role and effect of complementary and alternative medicine in systemic lupus erythematosus. Rheumatic Disease Clinics of North America. 2011;37:47.
  12. Systemic lupus erythematosus. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed Aug. 23, 2011.
DS00115 Oct. 26, 2011

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