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{{Systemic lupus erythematosus}}
{{Systemic lupus erythematosus}}


{{CMG}}; {{AE}} {{MIR}
{{CMG}}; {{AE}}<nowiki> {{MIR}</nowiki>


== Overview ==
== Overview ==
: An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name]
Laboratory findings consistent with the diagnosis of systemic lupus erythematosus include anemia, leukopenia or lymphopenia, elevated levels of ANA, anti-dsDNA, anti-SM and antiphospholipid, and decrease of complement levels.
: OR
: Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
Some patients with [disease name] may have elevated/reduced concentrations of [test], which is usually suggestive of [progression/complication].


== Laboratory tests ==
== Laboratory tests ==
Line 18: Line 15:
!
!
|-
|-
| rowspan="3" |Hematology
| rowspan="2" |Hematology
|Complete blood count
|Complete blood count
|leukopenia
mild anemia
thrombocytopenia
|
|
|
* Leukopenia
* Lymphopenia
* Mild anemia
* Thrombocytopenia
| colspan="2" |
|-
|-
|serum creatinine
|Serum creatinine
|Elevated  
|Elevated  
|suggestive of renal dysfunction
| colspan="2" |
|
* Suggestive of renal dysfunction
|-
|-
|Urinalysis with urine sediment
|Urine
|hematuria, pyuria, proteinuria, and/or cellular casts
|Urinalysis
|
Urine sediment
|
|
* Hematuria
* Pyuria
* Proteinuria
* Cellular casts
| colspan="2" |
|-
|-
| rowspan="12" |Serology
| rowspan="12" |Serology
|ANA
|ANA
|
|Elevated
|positive in virtually all patients with SLE at some time in the course of their disease
| colspan="2" |
|If the ANA is positive, one should test for other specific antibodies such as dsDNA, anti-Sm, Ro/SSA, La/SSB, and U1 ribonucleoprotein (RNP)
* Positive in virtually all patients with SLE at some time in the course of their disease
|-
|-
|Antiphospholipid antibodies
|Antiphospholipid antibodies
|lupus anticoagulant [LA], IgG and IgM anticardiolipin [aCL] antibodies; and IgG and IgM anti-beta2-glycoprotein [GP]
16420554
|
|
|
* Lupus anticoagulant [LA]
* IgG and IgM anticardiolipin [aCL] antibodies
* IgG and IgM anti-beta2-glycoprotein [GP]
| colspan="2" |
* aPLs are a heterogenous group of autoantibodies which are directed against phospholipid-binding proteins
|-
|-
|complement levels
|complement levels
|C3 and C4 or CH50
18075790
|
|
|
* C3: vary between varying between normal to slightly reduced
* C4: reduced
* CH50: reduced
| colspan="2" |
* Impaired clearance of immune complexes
* Impaired handling of apoptotic cells
* Aberrant tolerance induction or changes in cytokine regulation
* During disease flares, the complement system is activated giving rise to partial deficiency or dysfunction due to consumption
* Takes part in the inflammatory reaction in the diseases which lead to the tissue and organ damage
:
|-
|-
|Erythrocyte sedimentation rate (ESR)
|Erythrocyte sedimentation rate (ESR)
|
|Elevated
|
| colspan="2" |
|
|-
|-
|C-reactive protein (CRP)
|C-reactive protein (CRP)
|
|Elevated
|
| colspan="2" |
|
|-
|-
|Urine protein-to-creatinine ratio
|Urine protein-to-creatinine ratio
|
|Elevated
|
| colspan="2" |
|
|-
|-
|Anti-dsDNA
|Anti-dsDNA
|highly specific for SLE
|Elevated
 
| colspan="2" |
in 70% of patients
* Highly specific for SLE
|
* In 70% of patients
|
|-
|-
|anti-Sm antibodies  
|anti-Sm antibodies  
|highly specific for SLE
|Elevated
 
| colspan="2" |
lack sensitivity
* Highly specific for SLE  
* In 30% of patients


in 30% of patients
* Lack sensitivity
|
|
|-
|-
|Anti-Ro/SSA antibodies
|Anti-Ro/SSA antibodies
|in 30% of patients
more commonly associated with Sjögren’s syndrome
15593352
15593352
|
|Elevated
|
| colspan="2" |
* In 30% of patients
* More commonly associated with Sjögren’s syndrome
|-
|-
|anti-La/SSB antibodies
|anti-La/SSB antibodies
|in 20% of patients
more commonly associated with Sjögren’s syndrome
15593352
15593352
|
|Elevated
|
| colspan="2" |
* In 20% of patients
* More commonly associated with Sjögren’s syndrome
|-
|-
|Anti-U1 RNP antibodies
|Anti-U1 RNP antibodies
|in approximately 25 percent of patients with SLE
Not specific, always present in patients with mixed connective tissue disease (MCTD)
15593352
15593352
|
|Elevated
|
| colspan="2" |
* In approximately 25 percent of patients with SLE
* Not specific, always present in patients with mixed connective tissue disease (MCTD)
|-
|-
|Antiribosomal P protein antibodies
|Antiribosomal P protein antibodies
|high specificity for SLE & low sensitivity for SLE
|Elevated
lack specificity for involvement of a particular organ system or disease manifestation.
| colspan="2" |
* High specificity for SLE & low sensitivity for SLE
* Lack specificity for involvement of a particular organ system or disease manifestation
|-
|
|
|Direct Coombs' test
|Positive
|
* Clinically important in the absence of other causes of hemolytic anemia
|
|
|}
|}
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Laboratory exams to distinguish SLE from other diseases
Laboratory exams to distinguish SLE from other diseases
{| class="wikitable"
{| class="wikitable"
!
!
!
!
!
Line 127: Line 140:
|In patients with predominant arthralgias or arthritis may help exclude a diagnosis of rheumatoid arthritis (RA)
|In patients with predominant arthralgias or arthritis may help exclude a diagnosis of rheumatoid arthritis (RA)
higher specificity for RA and may be more useful for distinguishing the arthritis associated with RA. (See "Biologic markers in the diagnosis and assessment of rheumatoid arthritis", section on 'Rheumatoid factors' and "Biologic markers in the diagnosis and assessment of rheumatoid arthritis
higher specificity for RA and may be more useful for distinguishing the arthritis associated with RA. (See "Biologic markers in the diagnosis and assessment of rheumatoid arthritis", section on 'Rheumatoid factors' and "Biologic markers in the diagnosis and assessment of rheumatoid arthritis
|
|
|
|-
|-
|Rheumatoid factor (RF)
|Rheumatoid factor (RF)
|less diagnostic utility since 20 to 30 percent of people with SLE have a positive RF
|less diagnostic utility since 20 to 30 percent of people with SLE have a positive RF
|
|
|
|-
|-
Line 138: Line 149:
|serologic testing for human parvovirus B19
|serologic testing for human parvovirus B19
|In patients with a brief history (for example, less than six weeks) of predominant arthralgias or arthritis
|In patients with a brief history (for example, less than six weeks) of predominant arthralgias or arthritis
|
|-
|-
|serologic testing for hepatitis B virus (HBV) and hepatitis C virus (HCV)
|serologic testing for hepatitis B virus (HBV) and hepatitis C virus (HCV)
|in patients with multisystemic clinical findings
|in patients with multisystemic clinical findings
|
|-
|-
|serologic studies for Borrelia
|serologic studies for Borrelia
|n areas endemic for Lyme disease
|n areas endemic for Lyme disease
|
|-
|-
|Testing for Epstein-Barr virus (EBV)
|Testing for Epstein-Barr virus (EBV)
|
|
|
|-
|-
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|may reflect myositis, which is relatively uncommon in patients with SLE.  
|may reflect myositis, which is relatively uncommon in patients with SLE.  
|Myositis may also suggest an alternative diagnosis such as MCTD, polymyositis (PM), or dermatomyositis (DM).
|Myositis may also suggest an alternative diagnosis such as MCTD, polymyositis (PM), or dermatomyositis (DM).
|
|}
|}
:*
*[[Skin biopsy]]
*[[biopsy|Kidney biopsy]]


==References==
==References==

Revision as of 16:07, 16 June 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: {{MIR}

Overview

Laboratory findings consistent with the diagnosis of systemic lupus erythematosus include anemia, leukopenia or lymphopenia, elevated levels of ANA, anti-dsDNA, anti-SM and antiphospholipid, and decrease of complement levels.

Laboratory tests

Lab exam result clinical correlation
Hematology Complete blood count
  • Leukopenia
  • Lymphopenia
  • Mild anemia
  • Thrombocytopenia
Serum creatinine Elevated
  • Suggestive of renal dysfunction
Urine Urinalysis

Urine sediment

  • Hematuria
  • Pyuria
  • Proteinuria
  • Cellular casts
Serology ANA Elevated
  • Positive in virtually all patients with SLE at some time in the course of their disease
Antiphospholipid antibodies

16420554

  • Lupus anticoagulant [LA]
  • IgG and IgM anticardiolipin [aCL] antibodies
  • IgG and IgM anti-beta2-glycoprotein [GP]
  • aPLs are a heterogenous group of autoantibodies which are directed against phospholipid-binding proteins
complement levels

18075790

  • C3: vary between varying between normal to slightly reduced
  • C4: reduced
  • CH50: reduced
  • Impaired clearance of immune complexes
  • Impaired handling of apoptotic cells
  • Aberrant tolerance induction or changes in cytokine regulation
  • During disease flares, the complement system is activated giving rise to partial deficiency or dysfunction due to consumption
  • Takes part in the inflammatory reaction in the diseases which lead to the tissue and organ damage
Erythrocyte sedimentation rate (ESR) Elevated
C-reactive protein (CRP) Elevated
Urine protein-to-creatinine ratio Elevated
Anti-dsDNA Elevated
  • Highly specific for SLE
  • In 70% of patients
anti-Sm antibodies Elevated
  • Highly specific for SLE
  • In 30% of patients
  • Lack sensitivity
Anti-Ro/SSA antibodies

15593352

Elevated
  • In 30% of patients
  • More commonly associated with Sjögren’s syndrome
anti-La/SSB antibodies

15593352

Elevated
  • In 20% of patients
  • More commonly associated with Sjögren’s syndrome
Anti-U1 RNP antibodies

15593352

Elevated
  • In approximately 25 percent of patients with SLE
  • Not specific, always present in patients with mixed connective tissue disease (MCTD)
Antiribosomal P protein antibodies Elevated
  • High specificity for SLE & low sensitivity for SLE
  • Lack specificity for involvement of a particular organ system or disease manifestation
Direct Coombs' test Positive
  • Clinically important in the absence of other causes of hemolytic anemia

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

anti-cyclic citrullinated peptide (CCP) antibodies In patients with predominant arthralgias or arthritis may help exclude a diagnosis of rheumatoid arthritis (RA)

higher specificity for RA and may be more useful for distinguishing the arthritis associated with RA. (See "Biologic markers in the diagnosis and assessment of rheumatoid arthritis", section on 'Rheumatoid factors' and "Biologic markers in the diagnosis and assessment of rheumatoid arthritis

Rheumatoid factor (RF) less diagnostic utility since 20 to 30 percent of people with SLE have a positive RF
Serological studies for infection serologic testing for human parvovirus B19 In patients with a brief history (for example, less than six weeks) of predominant arthralgias or arthritis
serologic testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) in patients with multisystemic clinical findings
serologic studies for Borrelia n areas endemic for Lyme disease
Testing for Epstein-Barr virus (EBV)
Creatine kinase (CK) may reflect myositis, which is relatively uncommon in patients with SLE. Myositis may also suggest an alternative diagnosis such as MCTD, polymyositis (PM), or dermatomyositis (DM).

References

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