Lupus

Diagnosis

Diagnosing lupus is challenging because symptoms vary widely among individuals and can change over time. Lupus signs may overlap with other disorders, so no single test can confirm the diagnosis. A combination of blood and urine tests, physical examination, and assessment of symptoms leads to a diagnosis.

Laboratory tests

Blood and urine tests commonly used to help diagnose lupus include:

• Complete blood count to measure red and white blood cells and platelets, and to check hemoglobin levels. Abnormal results may indicate anemia, low white blood cell counts, or low platelets.
• Erythrocyte sedimentation rate to determine how quickly red blood cells settle in a tube. Elevated rates may indicate lupus or other inflammatory conditions.
• Kidney and liver function tests to assess how well these organs are working, since lupus can affect them.
• Urinalysis to check for increased protein or red blood cells in urine, which may indicate kidney involvement.
• Antinuclear antibody (ANA) test to detect antibodies produced by an overactive immune system. A positive ANA test may lead to more specific antibody testing.

Imaging tests

If lupus is suspected to affect the lungs or heart, imaging tests may include:

• Chest X-ray to identify fluid or inflammation in the lungs
• Echocardiogram to examine the heart valves and other structures using sound waves

Biopsy

Biopsies may be performed to guide treatment:

• Kidney biopsy to assess the type of lupus-related kidney damage
• Skin biopsy to confirm lupus affecting the skin

More Information
Antinuclear antibody (ANA) test
Complete blood count (CBC)
Echocardiogram
ENA test
Liver function tests

Treatment

Treatment for lupus depends on symptoms and their severity. Medication choices and dosages are adjusted over time based on symptom flares and remissions. Common treatments include:

Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Over-the-counter options like naproxen or ibuprofen reduce pain, swelling, and fever
• Prescription NSAIDs may be stronger
• Side effects can include stomach bleeding, kidney problems, and increased heart risk

Antimalarial drugs
• Medications such as hydroxychloroquine help control immune system activity and prevent flares
• Side effects may include stomach upset and rarely retinal damage, requiring regular eye exams

Corticosteroids
• Prednisone and other corticosteroids reduce inflammation
• High doses, like methylprednisolone, are used for serious disease affecting kidneys or brain
• Side effects may include weight gain, easy bruising, thinning bones, high blood pressure, diabetes, and infection risk

Immunosuppressants
• Drugs like azathioprine, mycophenolate, methotrexate, cyclosporine, and leflunomide suppress the immune system in severe cases
• Potential side effects include infection, liver damage, decreased fertility, and increased cancer risk

Biologics
• Belimumab administered intravenously can reduce lupus symptoms; side effects may include nausea, diarrhea, infections, and rarely worsened depression
• Rituximab may help if other treatments are ineffective; side effects include allergic reactions and infections
• Voclosporin has shown effectiveness in clinical trials
• Other drugs under study include abatacept, anifrolumab, and additional novel therapies