Systemic lupus erythematosus laboratory tests: Difference between revisions
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{| class="wikitable" | {| class="wikitable" | ||
! | ! style="background: #4479BA; color: #FFFFFF; " |<small><small>Exam type</small></small> | ||
!Lab exam | ! style="background: #4479BA; color: #FFFFFF; " |Lab exam | ||
!result | ! style="background: #4479BA; color: #FFFFFF; " |result | ||
!clinical correlation | ! style="background: #4479BA; color: #FFFFFF; " |clinical correlation | ||
|- | |- | ||
| rowspan="4" |Hematology | | rowspan="4" |<small>Hematology</small> | ||
|[[Complete blood count]] | | style="background: #DCDCDC; " |[[Complete blood count]] | ||
| | | | ||
* [[Leukopenia]] | * [[Leukopenia]] | ||
| Line 29: | Line 29: | ||
* May be related to constitutional symptoms | * May be related to constitutional symptoms | ||
|- | |- | ||
|[[Serum creatinine]] | | style="background: #DCDCDC; " |[[Serum creatinine]] | ||
|Elevated | |Elevated | ||
| | | | ||
* Suggestive of [[renal dysfunction]] | * Suggestive of [[renal dysfunction]] | ||
|- | |- | ||
|[[Amylase]] | | style="background: #DCDCDC; " |[[Amylase]] | ||
| rowspan="2" |Elevated | | rowspan="2" |Elevated | ||
| rowspan="2" | | | rowspan="2" | | ||
* Acute [[pancreatitis]] | * Acute [[pancreatitis]] | ||
|- | |- | ||
|[[Lipase]] | | style="background: #DCDCDC; " |[[Lipase]] | ||
|- | |- | ||
| rowspan="2" |Urine | | rowspan="2" |<small>Urine</small> | ||
|[[Urinalysis]] | | style="background: #DCDCDC; " |[[Urinalysis]] | ||
| rowspan="2" | | | rowspan="2" | | ||
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* Suggestive of [[renal dysfunction]] | * Suggestive of [[renal dysfunction]] | ||
|- | |- | ||
|Urine sediment | | style="background: #DCDCDC; " |Urine sediment | ||
|- | |- | ||
| rowspan="12" |Serology | | rowspan="12" |<small>Serology</small> | ||
|[[ANA]] | | style="background: #DCDCDC; " |[[ANA]] | ||
|Elevated | |Elevated | ||
| | | | ||
* Positive in virtually all patients with SLE at some time in the course of their disease | * Positive in virtually all patients with SLE at some time in the course of their disease | ||
|- | |- | ||
|Antiphospholipid antibodies | | style="background: #DCDCDC; " |Antiphospholipid antibodies | ||
| | | | ||
* [[Lupus anticoagulant]] [LA] | * [[Lupus anticoagulant]] [LA] | ||
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* Can be predictive of [[hematologic]] and [[Thromboembolic disease|thromboembolic]] involvement | * Can be predictive of [[hematologic]] and [[Thromboembolic disease|thromboembolic]] involvement | ||
|- | |- | ||
|[[Complement]] levels | | style="background: #DCDCDC; " |[[Complement]] levels | ||
| | | | ||
* C3: vary between varying between normal to slightly reduced | * C3: vary between varying between normal to slightly reduced | ||
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* [[Complement]] activity related to organ damage and [[Phagocytosis|auto-phagocytosis]] | * [[Complement]] activity related to organ damage and [[Phagocytosis|auto-phagocytosis]] | ||
|- | |- | ||
|[[Erythrocyte sedimentation rate|Erythrocyte sedimentation rate (ESR)]] | | style="background: #DCDCDC; " |[[Erythrocyte sedimentation rate|Erythrocyte sedimentation rate (ESR)]] | ||
|Elevated | |Elevated | ||
| | | | ||
* Non-specific | * Non-specific | ||
|- | |- | ||
|[[C-reactive protein|C-reactive protein (CRP)]] | | style="background: #DCDCDC; " |[[C-reactive protein|C-reactive protein (CRP)]] | ||
|Elevated | |Elevated | ||
| | | | ||
* Non-specific | * Non-specific | ||
|- | |- | ||
|Urine protein-to-creatinine ratio | | style="background: #DCDCDC; " |Urine protein-to-creatinine ratio | ||
|Elevated | |Elevated | ||
| | | | ||
* [[Lupus nephritis]] | * [[Lupus nephritis]] | ||
|- | |- | ||
|[[Anti-dsDNA antibody]] | | style="background: #DCDCDC; " |[[Anti-dsDNA antibody]] | ||
|Elevated | |Elevated | ||
| | | | ||
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* In 70% of patients | * In 70% of patients | ||
|- | |- | ||
|[[Anti-SM antibody|Anti-SM antibodies]] | | style="background: #DCDCDC; " |[[Anti-SM antibody|Anti-SM antibodies]] | ||
|Elevated | |Elevated | ||
| | | | ||
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* Lack sensitivity | * Lack sensitivity | ||
|- | |- | ||
|Anti-Ro/SSA antibodies | | style="background: #DCDCDC; " |Anti-Ro/SSA antibodies | ||
|Elevated | |Elevated | ||
| | | | ||
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* More commonly associated with [[Sjögren’s syndrome]] | * More commonly associated with [[Sjögren’s syndrome]] | ||
|- | |- | ||
|Anti-La/SSB antibodies | | style="background: #DCDCDC; " |Anti-La/SSB antibodies | ||
|Elevated | |Elevated | ||
| | | | ||
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* More commonly associated with [[Sjögren's syndrome|Sjögren’s syndrome]] | * More commonly associated with [[Sjögren's syndrome|Sjögren’s syndrome]] | ||
|- | |- | ||
|Anti-U1 RNP antibodies | | style="background: #DCDCDC; " |Anti-U1 RNP antibodies | ||
|Elevated | |Elevated | ||
| | | | ||
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* Not specific, always present in patients with [[mixed connective tissue disease]] (MCTD) | * Not specific, always present in patients with [[mixed connective tissue disease]] (MCTD) | ||
|- | |- | ||
|Antiribosomal P protein antibodies | | style="background: #DCDCDC; " |Antiribosomal P protein antibodies | ||
|Elevated | |Elevated | ||
| | | | ||
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|- | |- | ||
| | | | ||
|[[Coombs test|Direct Coombs' test]] | | style="background: #DCDCDC; " |[[Coombs test|Direct Coombs' test]] | ||
|Positive | |Positive | ||
| | | | ||
Revision as of 21:11, 31 July 2017
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Systemic lupus erythematosus Microchapters |
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Differentiating Systemic lupus erythematosus from other Diseases |
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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 autoantibodies elevation of ANA, anti-dsDNA antibody, anti-SM antibody and antiphospholipid antibodies, and decrease of complement levels. Non specific 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 autoantibodies elevation of ANA, anti-dsDNA antibody, anti-SM antibody and antiphospholipid antibodies, and decrease of complement levels.[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.