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== Overview ==
== Overview ==
Laboratory findings consistent with the diagnosis of systemic lupus erythematosus include auto-antibodies elevation of ANA, anti-dsDNA, anti-SM and antiphospholipid antibodies, and decrease of complement levels.
Laboratory findings consistent with the diagnosis of systemic lupus erythematosus include auto-antibodies elevation of [[ANA]], [[anti-dsDNA antibody]], [[anti-SM antibody]] and [[antiphospholipid antibodies]], and decrease of [[complement]] levels.


== Laboratory tests ==
== Laboratory tests ==
Laboratory findings consistent with the diagnosis of systemic lupus erythematosus include auto-antibodies elevation of ANA, anti-dsDNA, anti-SM and antiphospholipid antibodies, and decrease of complement levels.
Laboratory findings consistent with the diagnosis of systemic lupus erythematosus include auto-antibodies elevation of [[ANA]], [[anti-dsDNA antibody]], [[anti-SM antibody]] and [[antiphospholipid antibodies]], and decrease of [[complement]] levels.
 
=== General laboratory changes during SLE flares ===
{| class="wikitable"
{| class="wikitable"
!
!
Line 16: Line 18:
!
!
|-
|-
| rowspan="2" |Hematology
| rowspan="4" |Hematology
|Complete blood count
|[[Complete blood count]]
|
|
* Leukopenia
* [[Leukopenia]]
* Lymphopenia
* [[Lymphopenia]]
* Mild anemia
* Mild [[anemia]]
* Thrombocytopenia
* [[Thrombocytopenia]]
| colspan="2" |
| colspan="2" |
* Non-specific
* Non-specific
* May be related to constitutional symptoms
* May be related to constitutional symptoms
|-
|-
|Serum creatinine
|[[Serum creatinine]]
|Elevated  
|Elevated  
| colspan="2" |
| colspan="2" |
* Suggestive of renal dysfunction
* Suggestive of renal dysfunction
|-
|-
|[[Amylase]]
| rowspan="2" |Elevated
| rowspan="2" |
* Acute [[pancreatitis]]
|
|
|Amylase-Lipase
|-
|Elevated
|[[Lipase]]
|
* Acute pancreatitis
|
|
|-
|-
|Urine
| rowspan="2" |Urine
|Urinalysis
|[[Urinalysis]]
Urine sediment
 
|
| rowspan="2" |
* Hematuria
* [[Hematuria]]
* Pyuria
* [[Pyuria]]
* Proteinuria
* [[Proteinuria]]
* Cellular casts
* Cellular casts
| colspan="2" |
| colspan="2" rowspan="2" |
* Suggestive of renal dysfunction
* Suggestive of [[renal dysfunction]]
|-
|Urine sediment
|-
|-
| rowspan="12" |Serology
| rowspan="12" |Serology
|ANA
|[[ANA]]
|Elevated
|Elevated
| colspan="2" |
| colspan="2" |
Line 59: Line 65:
<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="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>
|
|
* Lupus anticoagulant [LA]
* [[Lupus anticoagulant]] [LA]
* IgG and IgM anticardiolipin [aCL] antibodies
* [[IgG]] and [[IgM]] [[Anti-cardiolipin antibodies|anticardiolipin [aCL] antibodies]]
* IgG and IgM anti-beta2-glycoprotein [GP]
* [[IgG]] and [[IgM]] anti-beta2-glycoprotein [GP]
| colspan="2" |
| colspan="2" |
* Can be predictive of hematologic and thromboembolic involvement
* Can be predictive of [[hematologic]] and [[Thromboembolic disease|thromboembolic]] involvement
|-
|-
|Complement levels
|[[Complement]] levels
<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="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>
|
|
Line 72: Line 78:
* CH50: reduced
* CH50: reduced
| colspan="2" |
| colspan="2" |
* Impaired clearance of immune complexes
* Impaired clearance of [[immune complexes]]
* Impaired handling of apoptotic cells
* Partial complement deficiency during disease flare ups
* Aberrant tolerance induction or changes in cytokine regulation
** Mostly due to [[complement]] over consumption
* During disease flares, the complement system is activated giving rise to partial deficiency or dysfunction due to consumption
* [[Complement]] activity related to organ damage and [[Phagocytosis|auto-phagocytosis]]
* Takes part in the inflammatory reaction in the diseases which lead to the tissue and organ damage  
:
|-
|-
|Erythrocyte sedimentation rate (ESR)
|[[Erythrocyte sedimentation rate|Erythrocyte sedimentation rate (ESR)]]
|Elevated
|Elevated
| colspan="2" |
| colspan="2" |
* Non-specific
* Non-specific
|-
|-
|C-reactive protein (CRP)
|[[C-reactive protein|C-reactive protein (CRP)]]
|Elevated
|Elevated
| colspan="2" |
| colspan="2" |
Line 92: Line 96:
|Elevated
|Elevated
| colspan="2" |
| colspan="2" |
* Lupus nephritis
* [[Lupus nephritis]]
|-
|-
|Anti-dsDNA
|[[Anti-dsDNA antibody]]
|Elevated
|Elevated
| colspan="2" |
| colspan="2" |
Line 100: Line 104:
* In 70% of patients
* In 70% of patients
|-
|-
|Anti-Sm antibodies  
|[[Anti-SM antibody|Anti-SM antibodies]]
|Elevated
|Elevated
| colspan="2" |
| colspan="2" |
Line 113: Line 117:
| colspan="2" |
| colspan="2" |
* In 30% of patients
* In 30% of patients
* More commonly associated with Sjögren’s syndrome
* More commonly associated with [[Sjögren’s syndrome]]
|-
|-
|anti-La/SSB antibodies
|Anti-La/SSB antibodies
<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>
<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>
|Elevated
|Elevated
| colspan="2" |
| colspan="2" |
* In 20% of patients
* In 20% of patients
* More commonly associated with Sjögren’s syndrome  
* More commonly associated with [[Sjögren's syndrome|Sjögren’s syndrome]]
|-
|-
|Anti-U1 RNP antibodies
|Anti-U1 RNP antibodies
Line 127: Line 131:
| colspan="2" |
| colspan="2" |
* In approximately 25 percent of patients with SLE
* In approximately 25 percent 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)
|-
|-
|Antiribosomal P protein antibodies
|Antiribosomal P protein antibodies
Line 136: Line 140:
|-
|-
|
|
|Direct Coombs' test
|[[Coombs test|Direct Coombs' test]]
|Positive
|Positive
|
|
Line 145: Line 149:
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.  
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
=== Laboratory exams to distinguish SLE from other diseases ===
{| class="wikitable"
{| class="wikitable"
!Test
!Test
!Interpretation
!Interpretation
|-
|-
|anti-cyclic citrullinated peptide (CCP) antibodies
|Anti-cyclic citrullinated peptide (CCP) antibodies
|
|
* 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
* Higher specificity for [[RA]]
|-
|-
|Rheumatoid factor (RF)
|Rheumatoid factor (RF)
|
|
* Less diagnostic since only 20 to 30 percent of people with SLE have a positive RF
* Less diagnostic since only 20 to 30 percent of people with SLE have a positive RF
* Consider [[RA]]
|-
|-
| rowspan="4" |Serological studies for infection
| rowspan="4" |Serological studies for infection
|
|
* Serologic testing for human parvovirus B19
* [[Serologic]] testing for [[Human parvovirus B19 infection|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|hepatitis B virus (HBV)]] and [[Hepatitis C virus|hepatitis C virus (HCV)]]
** In patients with multi-systemic clinical findings
** In patients with multi-systemic clinical findings
|-
|-
|
|
* Serologic studies for Borrelia
* Serologic studies for [[borrelia]]
** Especially in areas endemic for Lyme disease
** Especially in areas endemic for [[lyme disease]]
|-
|-
|
|
* Testing for Epstein-Barr virus (EBV)
* Testing for [[Epstein-Barr virus|Epstein-Barr virus (EBV)]]
|-
|-
|Creatine kinase (CK)
|Creatine kinase (CK)
|
|
* Can reflect myositis (relatively uncommon in patients with SLE)
* Can reflect [[myositis]] (relatively uncommon in patients with SLE)
* Myositis may also suggest an alternative diagnosis such as:
* Myositis may also suggest an alternative diagnosis such as:
** MCTD
** [[Mixed connective tissue disease|MCTD]]
** Polymyositis (PM)
** [[Polymyositis|Polymyositis (PM)]]
** Dermatomyositis (DM)
** [[Dermatomyositis|Dermatomyositis (DM)]]
|}
|}


Line 191: Line 196:
!Pathogenesis involvement
!Pathogenesis involvement
|-
|-
|ANA
|[[ANA]]
|80
|80
| -
| -
|Cutaneous lupus erythematosus
|[[Cutaneous lupus erythematosus]]
|-
|-
|dsDNA
|dsDNA
|70
|70
| -/+
| -/+
|Lupus nephritis
|[[Lupus nephritis]]
|-
|Nucleosomes
|60
| +
|Lupus nephritis
|-
|-
|Anti-Sm antibodies
|Anti-Sm antibodies
|30
|30
| -
| -
|Renal, neurologic, vasculitis and hematologic disorders are more prevalent
|Renal, neurologic, vasculitis and hematologic disorders
|-
|-
|snRNP (U1 RNP)
|snRNP (U1 RNP)
Line 219: Line 219:
|30
|30
| -
| -
|Neonatal lupus
|[[Neonatal lupus]]
|-
|-
|SSB/La
|SSB/La
|20
|20
| -
| -
|Neonatal lupus
|[[Neonatal lupus]]
|-
|-
|Antiribosomal P protein antibodies
|Antiribosomal P protein antibodies
|20
|20
| -
| -
|Neuropsychiatri c symptoms, liver disease
|Neuro-psychiatric disease, [[liver disease]]
|-
|-
|RF
|RF

Revision as of 22:25, 15 July 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 auto-antibodies elevation of ANA, anti-dsDNA antibody, anti-SM antibody and antiphospholipid antibodies, and decrease of complement levels.

Laboratory tests

Laboratory findings consistent with the diagnosis of systemic lupus erythematosus include auto-antibodies elevation of ANA, anti-dsDNA antibody, anti-SM antibody and antiphospholipid antibodies, and decrease of complement levels.

General laboratory changes during SLE flares

Lab exam result clinical correlation
Hematology Complete blood count
  • Non-specific
  • May be related to constitutional symptoms
Serum creatinine Elevated
  • Suggestive of renal dysfunction
Amylase Elevated
Lipase
Urine Urinalysis
Urine sediment
Serology ANA Elevated
  • Positive in virtually all patients with SLE at some time in the course of their disease
Antiphospholipid antibodies

[1]

Complement levels

[2]

  • C3: vary between varying between normal to slightly reduced
  • C4: reduced
  • CH50: reduced
Erythrocyte sedimentation rate (ESR) Elevated
  • Non-specific
C-reactive protein (CRP) Elevated
  • Non-specific
Urine protein-to-creatinine ratio Elevated
Anti-dsDNA antibody 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

[3]

Elevated
Anti-La/SSB antibodies

[3]

Elevated
Anti-U1 RNP antibodies

[3]

Elevated
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

Test Interpretation
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
Rheumatoid factor (RF)
  • Less diagnostic since only 20 to 30 percent of people with SLE have a positive RF
  • Consider RA
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 disorders
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

  1. ↑ 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.
  2. ↑ Truedsson L, Bengtsson AA, Sturfelt G (2007). "Complement deficiencies and systemic lupus erythematosus". Autoimmunity. 40 (8): 560–6. doi:10.1080/08916930701510673. PMID 18075790.
  3. ↑ 3.0 3.1 3.2 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.

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