How Is Lupus Diagnosed?
Many rheumatologists use the 11 criteria from the American College of Rheumatology (ACR), established in 1982, in order to diagnose systemic lupus. These criteria are:
- Having a malar rash.
- Having a discoid (skin) rash.
- Ulcers in the mouth or nose.
- Lupus arthritis (nonerosive arthritis in two or more joints).
- Signs of cardio-pulmonary involvement (such as pericarditis or pleurisy).
- Signs of neurological issues (such as seizures or psychosis).
- Kidney involvement.
- Blood disorder (such as low white blood cell count or low platelet count).
- Immune issues (such as antibodies to double-stranded DNA, Sm, or cardiolipin)
- Antinuclear antibodies (in the absence of drugs known to induce them).
Most rheumatologists will use the four criteria rule to diagnose lupus – meaning you must have at least four of the above criteria in order to be diagnosed.
When I first visited my rheumatologist, I only exhibited three of the criteria, and so he initially diagnosed me with early lupus or, less specifically, undifferentiated mixed connective tissue disease.
However, within two additional months, I had symptoms that matched five of the criteria and received a full lupus diagnosis.
If lupus is suspected, it can be helpful to go back for more tests or frequent monitoring to possibly find additional diagnostic evidence, as some symptoms may only be evident for a short period of time or during flares.
How Lupus Affects the Body
The variety of ways that lupus can affect the body would be impressive if it weren’t such a sorrowful topic. There are very few body parts that are truly off limits.
Lupus and Your Kidneys
When lupus attacks the kidneys, it is called lupus nephritis. Nephritis occurs when the parts of the kidneys that filter blood become inflamed and can no longer function properly.
Signs of kidney inflammation include high blood pressure, sudden and intense swelling, increased urination, and foamy urine.
Lupus nephritis affects up to 50 percent of people with lupus, and up to 30 percent of people will progress to kidney failure.
While kidney disease is often caught early and managed well, it is ultimately one of the leading causes of death for people with lupus (particularly for African Americans). In fact, it was the number one cause of lupus fatalities before modern treatments such as dialysis and kidney transplantation.
Lupus and the Cardiovascular System
Lupus tends to cause inflammation in the outer membrane of the heart (called pericarditis), which can lead to sharp chest pain or shortness of breath. It can also inflame the heart muscle (myocarditis), its inner membrane (endocarditis), or the arteries. Over time, inflammation can scar the heart tissue and restrict its function.
People with lupus have a high risk of cardiovascular disease, artery disease, circulatory issues, and heart attacks. Cardiovascular issues are currently the leading cause of death for people with lupus.
Lupus and the Lungs
There are several lupus-related lung issues, including pleurisy, pneumonitis, pulmonary hypertension, and reduced lung volume.
Pleurisy occurs when the membrane around the lungs becomes inflamed – a painful condition that tends to happen during lupus flares.
About 50 percent of people with lupus will experience lung involvement of some kind. Many of those affected will suffer from breathlessness, lung disease, or possibly lung failure.
Lupus and Your Skin
Approximately two-thirds of people with lupus experience skin problems. The inflamed skin may have lesions, red, scaly patches, or a rash that looks and feels like a sunburn.
People with discoid lupus may have scarring, skin discoloration, or hair loss due to skin lesions.
The Brain and Nervous System, and Lupus
There are several ways that lupus can affect the brain and nervous system beyond the typical cognitive dysfunctions.
Some people may experience lupus headaches, brain inflammation, seizures, strokes, vision problems, or mood disorders.
The ACR has defined 19 different lupus related neuropsychiatric syndromes, and there may be more than have not yet been recognized.
Lupus and Your Blood and Blood Vessels
Blood vessels can become inflamed (a condition called vasculitis) due to lupus.
Other blood problems include anemia and increased risk of bleeding or blood clotting – especially if lupus coincides with antiphospholipid syndrome (APS). Around 20 percent of people with SLE will have APS as well.
Next Page: How lupus affects the body? contd. And treatment for lupus information, and self-care tips for living with lupus.