Systemic lupus erythematosus laboratory tests: Difference between revisions
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== Laboratory tests == | == Laboratory tests == | ||
Laboratory findings consistent with the diagnosis of systemic lupus erythematosus include [[autoantibody]] elevation of [[ANA]], [[anti-dsDNA antibody]], [[anti-SM antibody]] and [[antiphospholipid antibodies]], | Laboratory findings consistent with the diagnosis of systemic lupus erythematosus include [[autoantibody]] elevation of [[ANA]], [[anti-dsDNA antibody]], [[anti-SM antibody]] and [[antiphospholipid antibodies]]. However, decrease of [[complement]] levels is a common finding in SLE.<ref name="pmid2646863">{{cite journal |vauthors=Tan EM |title=Antinuclear antibodies: diagnostic markers for autoimmune diseases and probes for cell biology |journal=Adv. Immunol. |volume=44 |issue= |pages=93–151 |year=1989 |pmid=2646863 |doi= |url=}}</ref><ref name="pmid23316252">{{cite journal |vauthors=Willitzki A, Hiemann R, Peters V, Sack U, Schierack P, Rödiger S, Anderer U, Conrad K, Bogdanos DP, Reinhold D, Roggenbuck D |title=New platform technology for comprehensive serological diagnostics of autoimmune diseases |journal=Clin. Dev. Immunol. |volume=2012 |issue= |pages=284740 |year=2012 |pmid=23316252 |pmc=3536031 |doi=10.1155/2012/284740 |url=}}</ref><ref name="pmid24864270">{{cite journal |vauthors=Li J, Leng X, Li Z, Ye Z, Li C, Li X, Zhu P, Wang Z, Zheng Y, Li X, Zhang M, Tian XP, Li M, Zhao J, Zhang FC, Zhao Y, Zeng X |title=Chinese SLE treatment and research group registry: III. association of autoantibodies with clinical manifestations in Chinese patients with systemic lupus erythematosus |journal=J Immunol Res |volume=2014 |issue= |pages=809389 |year=2014 |pmid=24864270 |pmc=4017718 |doi=10.1155/2014/809389 |url=}}</ref><ref name="pmid25449682">{{cite journal |vauthors=Yaniv G, Twig G, Shor DB, Furer A, Sherer Y, Mozes O, Komisar O, Slonimsky E, Klang E, Lotan E, Welt M, Marai I, Shina A, Amital H, Shoenfeld Y |title=A volcanic explosion of autoantibodies in systemic lupus erythematosus: a diversity of 180 different antibodies found in SLE patients |journal=Autoimmun Rev |volume=14 |issue=1 |pages=75–9 |year=2015 |pmid=25449682 |doi=10.1016/j.autrev.2014.10.003 |url=}}</ref><ref name="pmid16420554">{{cite journal |vauthors=Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, Derksen RH, DE Groot PG, Koike T, Meroni PL, Reber G, Shoenfeld Y, Tincani A, Vlachoyiannopoulos PG, Krilis SA |title=International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS) |journal=J. Thromb. Haemost. |volume=4 |issue=2 |pages=295–306 |year=2006 |pmid=16420554 |doi=10.1111/j.1538-7836.2006.01753.x |url=}}</ref><ref name="pmid18075790">{{cite journal |vauthors=Truedsson L, Bengtsson AA, Sturfelt G |title=Complement deficiencies and systemic lupus erythematosus |journal=Autoimmunity |volume=40 |issue=8 |pages=560–6 |year=2007 |pmid=18075790 |doi=10.1080/08916930701510673 |url=}}</ref><ref name="pmid15593352">{{cite journal |vauthors=Benito-Garcia E, Schur PH, Lahita R |title=Guidelines for immunologic laboratory testing in the rheumatic diseases: anti-Sm and anti-RNP antibody tests |journal=Arthritis Rheum. |volume=51 |issue=6 |pages=1030–44 |year=2004 |pmid=15593352 |doi=10.1002/art.20836 |url=}}</ref> | ||
=== Laboratory changes in SLE: === | === Laboratory changes in SLE: === | ||
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| style="background: #DCDCDC; " |Antiphospholipid antibodies | | style="background: #DCDCDC; " |Antiphospholipid antibodies | ||
| | | | ||
* [[Lupus anticoagulant]] | * [[Lupus anticoagulant]] (LA) | ||
* [[IgG]] and [[IgM]] [[Anti-cardiolipin antibodies|anticardiolipin | * [[IgG]] and [[IgM]] [[Anti-cardiolipin antibodies|anticardiolipin (aCL) antibodies]] | ||
* [[IgG]] and [[IgM]] anti-beta2-glycoprotein | * [[IgG]] and [[IgM]] anti-beta2-glycoprotein (GP) | ||
| | | | ||
* Can be predictive of [[hematologic]] and [[Thromboembolic disease|thromboembolic]] involvement | * Can be predictive of [[hematologic]] and [[Thromboembolic disease|thromboembolic]] involvement | ||
| Line 70: | Line 70: | ||
| style="background: #DCDCDC; " |[[Complement]] levels | | style="background: #DCDCDC; " |[[Complement]] levels | ||
| | | | ||
* C3: | * C3: Vary between varying between normal to slightly reduced | ||
* C4: | * C4: Reduced | ||
* CH50: | * CH50: Reduced | ||
| | | | ||
* Impaired clearance of [[immune complexes]] | * Impaired clearance of [[immune complexes]] | ||
| Line 98: | Line 98: | ||
| | | | ||
* Highly specific for SLE | * Highly specific for SLE | ||
* | * As high as 70% of patients | ||
|- | |- | ||
| style="background: #DCDCDC; " |[[Anti-SM antibody|Anti-SM antibodies]] | | style="background: #DCDCDC; " |[[Anti-SM antibody|Anti-SM antibodies]] | ||
| Line 104: | Line 104: | ||
| | | | ||
* Highly specific for SLE | * Highly specific for SLE | ||
* | * Positive in 30% of patients | ||
* Lack sensitivity | * Lack sensitivity | ||
| Line 111: | Line 111: | ||
|Elevated | |Elevated | ||
| | | | ||
* | * Positive in 30% of patients | ||
* More commonly associated with [[Sjögren’s syndrome]] | * More commonly associated with [[Sjögren’s syndrome]] | ||
|- | |- | ||
| Line 117: | Line 117: | ||
|Elevated | |Elevated | ||
| | | | ||
* | * Positive in 20% of patients | ||
* More commonly associated with [[Sjögren's syndrome|Sjögren’s syndrome]] | * More commonly associated with [[Sjögren's syndrome|Sjögren’s syndrome]] | ||
|- | |- | ||
| Line 123: | Line 123: | ||
|Elevated | |Elevated | ||
| | | | ||
* | * Positive in approximately 25% of patients with SLE | ||
* Not specific, always present in patients with [[mixed connective tissue disease]] (MCTD) | * Not specific, always present in patients with [[mixed connective tissue disease]] (MCTD) | ||
|- | |- | ||
Latest revision as of 19:55, 2 August 2017
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Systemic lupus erythematosus Microchapters |
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Differentiating Systemic lupus erythematosus from other Diseases |
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Systemic lupus erythematosus laboratory tests On the Web |
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Directions to Hospitals Treating Systemic lupus erythematosus |
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Risk calculators and risk factors for Systemic lupus erythematosus laboratory tests |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]
Overview
Laboratory findings consistent with the diagnosis of systemic lupus erythematosus include autoantibody elevation of ANA, anti-dsDNA antibody, anti-SM antibody, and antiphospholipid antibodies, and a decrease in complement levels. Nonspecific laboratory findings include mild pancytopenia, elevated levels of creatinine and proteinuria due to renal failure (secondary to nephritis), elevated levels of ESR and CRP as acute phase reactants, decreased level of complements, and positive direct Coombs test.
Laboratory tests
Laboratory findings consistent with the diagnosis of systemic lupus erythematosus include autoantibody elevation of ANA, anti-dsDNA antibody, anti-SM antibody and antiphospholipid antibodies. However, decrease of complement levels is a common finding in SLE.[1][2][3][4][5][6][7]
Laboratory changes in SLE:
| Exam type | Lab exam | Result | Clinical correlation |
|---|---|---|---|
| Hematology | Complete blood count |
| |
| Serum creatinine | Elevated |
| |
| Amylase | Elevated |
| |
| Lipase | |||
| Urine | Urinalysis |
|
|
| Urine sediment | |||
| Serology | ANA | Elevated |
|
| Antiphospholipid antibodies |
|
| |
| Complement levels |
|
| |
| Erythrocyte sedimentation rate (ESR) | Elevated |
| |
| C-reactive protein (CRP) | Elevated |
| |
| Urine protein-to-creatinine ratio | Elevated | ||
| Anti-dsDNA antibody | Elevated |
| |
| Anti-SM antibodies | Elevated |
| |
| Anti-Ro/SSA antibodies | Elevated |
| |
| Anti-La/SSB antibodies | Elevated |
| |
| Anti-U1 RNP antibodies | Elevated |
| |
| Antiribosomal P protein antibodies | Elevated |
| |
| Direct Coombs' test | Positive |
|
If the initial ANA test is negative, but the clinical suspicion of SLE is high, then additional antibody testing may still be appropriate. This is partly related to the differences in the sensitivity and specificity among the methods used to detect ANA.
Laboratory exams to distinguish SLE from other diseases
| Test | Interpretation |
|---|---|
| Anti-cyclic citrullinated peptide (CCP) antibodies |
|
| Rheumatoid factor (RF) | |
| Serological studies for infection |
|
| |
| |
| |
| Creatine kinase (CK) |
A more detailed look into auto-antibodies in SLE
| Antibodies | Prevalence | Association with disease activity | Pathogenesis involvement |
|---|---|---|---|
| ANA | 80 | - | Cutaneous lupus erythematosus |
| dsDNA | 70 | -/+ | Lupus nephritis |
| Anti-Sm antibodies | 30 | - | Renal, neurologic, vasculitis and hematologic diseases |
| snRNP (U1 RNP) | 30-40 | - | - |
| SSA/Ro | 30 | - | Neonatal lupus |
| SSB/La | 20 | - | Neonatal lupus |
| Antiribosomal P protein antibodies | 20 | - | Neuro-psychiatric disease, liver disease |
| RF | 20 | - | - |
References
- ↑ Tan EM (1989). "Antinuclear antibodies: diagnostic markers for autoimmune diseases and probes for cell biology". Adv. Immunol. 44: 93–151. PMID 2646863.
- ↑ Willitzki A, Hiemann R, Peters V, Sack U, Schierack P, Rödiger S, Anderer U, Conrad K, Bogdanos DP, Reinhold D, Roggenbuck D (2012). "New platform technology for comprehensive serological diagnostics of autoimmune diseases". Clin. Dev. Immunol. 2012: 284740. doi:10.1155/2012/284740. PMC 3536031. PMID 23316252.
- ↑ Li J, Leng X, Li Z, Ye Z, Li C, Li X, Zhu P, Wang Z, Zheng Y, Li X, Zhang M, Tian XP, Li M, Zhao J, Zhang FC, Zhao Y, Zeng X (2014). "Chinese SLE treatment and research group registry: III. association of autoantibodies with clinical manifestations in Chinese patients with systemic lupus erythematosus". J Immunol Res. 2014: 809389. doi:10.1155/2014/809389. PMC 4017718. PMID 24864270.
- ↑ Yaniv G, Twig G, Shor DB, Furer A, Sherer Y, Mozes O, Komisar O, Slonimsky E, Klang E, Lotan E, Welt M, Marai I, Shina A, Amital H, Shoenfeld Y (2015). "A volcanic explosion of autoantibodies in systemic lupus erythematosus: a diversity of 180 different antibodies found in SLE patients". Autoimmun Rev. 14 (1): 75–9. doi:10.1016/j.autrev.2014.10.003. PMID 25449682.
- ↑ Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, Derksen RH, DE Groot PG, Koike T, Meroni PL, Reber G, Shoenfeld Y, Tincani A, Vlachoyiannopoulos PG, Krilis SA (2006). "International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)". J. Thromb. Haemost. 4 (2): 295–306. doi:10.1111/j.1538-7836.2006.01753.x. PMID 16420554.
- ↑ Truedsson L, Bengtsson AA, Sturfelt G (2007). "Complement deficiencies and systemic lupus erythematosus". Autoimmunity. 40 (8): 560–6. doi:10.1080/08916930701510673. PMID 18075790.
- ↑ Benito-Garcia E, Schur PH, Lahita R (2004). "Guidelines for immunologic laboratory testing in the rheumatic diseases: anti-Sm and anti-RNP antibody tests". Arthritis Rheum. 51 (6): 1030–44. doi:10.1002/art.20836. PMID 15593352.