Systemic Lupus Erythematosus - Diagnosis

Highlights	Complications	Lifestyle Changes
Introduction	Diagnosis	Resources
Causes	Treatment	References
Risk Factors	Treatment for Cutaneous and Mild SLE
Symptoms	Treatment for Severe SLE

Diagnosis

No single test can definitively confirm or rule out SLE. A number of tests are required before SLE can be diagnosed definitively. The first symptoms of SLE can resemble one of many syndromes or disorders, including rheumatoid arthritis, Still's disease, rheumatic fever, Lyme disease, multiple sclerosis, thrombotic thrombocytopenia purpura, cryoglobulinemia, Weber-Christian disease, viral infections, vasculitis, psychosis, and other conditions. Other autoimmune disorders, such as Sjogren's syndrome or scleroderma, may even be present at the same time as SLE.

Criteria for Diagnosing System Lupus Erythematosus

1. Characteristic rash across the cheek

2. Discoid lesion rash

3. Photosensitivity

4. Oral ulcers

5. Arthritis

6. Inflammation of membranes in the lungs, the heart, or the abdomen

7. Evidence of kidney disease

8. Evidence of severe neurologic disease

9. Blood disorders, including low red and white blood cell and platelet counts

10. Immunologic abnormalities

11. Positive antinuclear antibody (ANA)

Note: Four of the criteria must be experienced by a patient before a classification of SLE can be made. These criteria, proposed by the American College of Rheumatology, are not to be relied upon solely for diagnosis, however.

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Ruling out Other Conditions

The doctor should first rule out common conditions that might be causing the symptoms. The doctor may test the synovial fluid (the lubricating liquid surrounding joints) to rule out rheumatoid arthritis, which is also an autoimmune disease and can occur with SLE. Certain eye and saliva tests may be used if Sjögren's syndrome is suspected.

A number of conditions may resemble SLE:

Scleroderma: Hardening of the skin caused by overproduction of collagen
Multiple sclerosis: Fatigue, heaviness or clumsiness in the arms and legs
Rheumatoid arthritis: Inflammation of the lining of the joints
Sjögren's syndrome: Characterized by dry eyes and dry mouth
Mixed connective tissue disorder: Similar to SLE, but milder
Myositis: Inflammation and degeneration of muscle tissues
Fibromyalgia: Chronic muscle pain
Rosacea: Flushed face with pus-filled blisters
Seborrheic dermatitis: Sores on lips and nose
Lichen planus: Swollen rash that itches, typically on scalp, arms, legs, or in the mouth
Leukoplakia: White spots on tongue or cheek
Dermatomyositis: Bluish-red skin eruptions on face and upper body
Lyme Disease: Bulls-eye rash, joint inflammation, and flu-like symptoms

Lyme disease is an acute inflammatory disease that is caused by the bacterium Borrelia burgdorferi. The bacteria is transmitted by the bite of a deer tick. Symptoms may go away in 3 to 4 weeks even without treatment, but other diseases may develop if the initial infection is not treated.