Diagnosis and Monitoring Lupus

Reviewed by: HU Medical Review Board | Last reviewed: January 2020

Unlike many other diseases, no one symptom or test result means that you have lupus. Instead, your doctor will use a combination of lab tests, your medical history, and current symptoms to diagnose you. It may take several visits to get an accurate diagnosis.

Because lupus symptoms are so similar to other autoimmune disorders, your doctor will have to rule out other diseases like rheumatoid arthritis, scleroderma, Lyme disease, and arthritis caused by a drug or virus.1

Lupus diagnostic criteria

Doctors in the U.S. use a set of diagnostic criteria (a list of symptoms) to decide if someone has lupus. Launched in 2019, it is called the European League Against Rheumatism/American College of Rheumatology Classification for Systemic Lupus Erythematosus (EULAR/ACR). This tool lists specific symptoms that your doctor can see, symptoms you report, your medical history, plus test results, and assigns points to each of these criteria to decide whether you have lupus.

Older diagnostic tools you may still hear about are known as:

  • 1997 Update of the 1982 American College of Rheumatology Revised Criteria for Classification of Systemic Lupus Erythematosus (ACR)
  • 2012 Systemic Lupus International Collaborating Clinics Classification Criteria for Systemic Lupus Erythematosus (SLICC)

These older criteria are similar to the 2019 classification system but are considered less accurate than the newest diagnostic tool.2-4

Medical history

Your doctor will ask about your medical history and whether you have any family members with lupus or other autoimmune diseases. It will help your doctor if you track your symptoms, such as joint pain and swelling, rash, or fevers. Since lupus can be unpredictable, you may not have any visible symptoms by the time you get to your doctor’s appointment. Your personal record should note how long these signs last and how mild, moderate or severe each was.

Physical examination

Your doctor will examine you for common symptoms of lupus, such as malar ("butterfly") rash, discoid rash, hair loss, arthritis, mouth ulcers, and more. Your doctor will also ask when you started experiencing symptoms, how often they occur, and whether anything seems to make your symptoms better or worse. Finally, your doctor will run a series of lab tests.

Laboratory tests

Laboratory tests help your doctor form a complete picture of your overall health. There are several specific tests that can help your doctor decide whether lupus, or some other autoimmune disease, is the cause of your joint pain, fatigue, and other symptoms. Tests that may indicate a diagnosis of lupus include:

  • Comprehensive metabolic panel
  • Complete blood counts to measure
  • The rate of breakdown of red blood cells
  • Levels of white blood cells and platelets
  • Immunologic tests to measure
  • Anti-DNA
  • Anti-Sm nuclear antigen
  • Antiphospholipid antibodies
  • Positive antinuclear antibody (ANA)
  • AVISE® CTD to confirm a positive ANA test
  • Urinalysis to check kidney function
  • Biopsy of skin lesions or kidney2-4

Imaging tests

Your doctor may have x-rays taken of the joints where you experience pain and swelling, and of your chest. X-rays can reveal signs of inflammation to the heart and lungs, and damage to the bones (called bone erosion) that may point to lupus. Other tests that may be useful in diagnosing lupus include an electrocardiogram to see how well your heart is working and an MRI of the brain or heart.

Monitoring lupus

Once you have been diagnosed with lupus, your doctor will want to monitor your health regularly, usually every 3 to 6 months. Some of the same blood, urine, and imaging tests used to diagnose lupus are also used to track disease progression. Close monitoring helps slow or prevent damage to your kidneys, heart, joints, and bones, helps you better control your symptoms, and improves your quality of life.

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