Lupus erythematosus – diagnosis

Lupus erythematosus - diagnosis

Since the symptoms of systemic lupus erythematosus (SLE) can be so diverse, diagnosing lupus is often challenging. It is not uncommon for people affected by lupus to be treated by their family doctor or rheumatologist for longer because of the joint problems before the lupus diagnosis is considered. Various parameters are taken into account when diagnosing lupus. Several tools are available for diagnosing lupus and assessing the course of the disease.

Lupus: Diagnosis thanks to ACR criteria

For many years, the American College of Rheumatology (ACR) has established a catalogue of criteria to help diagnose lupus. This includes eleven criteria – both typical lupus symptoms and complaints such as skin changes and joint pain as well as laboratory findings such as blood changes (reduced number of red or white blood cells or platelets), specific autoantibodies in the blood (against DNA, ribonucleoproteins, phospholipids) and in the Microscopy (antinuclear antibodies = ANA).

If four of the eleven criteria are present, the diagnosis of SLE is considered likely (80-90 per cent).


Lupus diagnosis using SLE indices

In addition to the widespread ACR catalogue, there are various other lists of criteria that can be used to diagnose and assess the disease’s severity. This, in turn, is necessary to optimize lupus therapy. These indices also evaluate complaints, examination results and laboratory values, sometimes even separately according to organ systems.

All have advantages and disadvantages. Some do not consider the worsening of existing symptoms, others do not consider subjective complaints such as tiredness, and others do not distinguish between mild symptoms and organ changes. Some are more appropriate than others for assessing the disease in children.

Here are the most critical lupus indices:

  • Systemic Lupus activity measure (SLAM): scale with three degrees of severity
  • British Siles Lupus Assessment Group (BILAG): Scale with four degrees of severity
  • Systemic Lupus erythematosus disease activity index (SLEDAI)
  • SLE-“damage-Index”
  • European Consensus Lupus Activity Measurement (ECLAN)

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