Systemic lupus erythematosus laboratory tests: Difference between revisions
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== Overview == | == Overview == | ||
Laboratory findings consistent with the diagnosis of systemic lupus erythematosus include | 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. | ||
== Laboratory tests == | == Laboratory tests == | ||
Laboratory findings consistent with the diagnosis of systemic lupus erythematosus include | 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.<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> | ||
=== General laboratory changes during SLE flares === | === General laboratory changes during SLE flares === | ||
{| class="wikitable" | {| class="wikitable" | ||
! | ! | ||
| Line 33: | Line 33: | ||
|Elevated | |Elevated | ||
| colspan="2" | | | colspan="2" | | ||
* Suggestive of renal dysfunction | * Suggestive of [[renal dysfunction]] | ||
|- | |- | ||
|[[Amylase]] | |[[Amylase]] | ||
| Line 63: | Line 63: | ||
* 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 | |Antiphospholipid antibodies<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] | ||
| Line 72: | Line 71: | ||
* Can be predictive of [[hematologic]] and [[Thromboembolic disease|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> | |||
| | | | ||
* C3: vary between varying between normal to slightly reduced | * C3: vary between varying between normal to slightly reduced | ||
| Line 80: | Line 78: | ||
| colspan="2" | | | colspan="2" | | ||
* Impaired clearance of [[immune complexes]] | * Impaired clearance of [[immune complexes]] | ||
* Partial complement deficiency during disease flare ups | * Partial [[complement]] deficiency during disease flare ups | ||
** Mostly due to [[complement]] over consumption | ** Mostly due to [[complement]] over consumption | ||
* [[Complement]] activity related to organ damage and [[Phagocytosis|auto-phagocytosis]] | * [[Complement]] activity related to organ damage and [[Phagocytosis|auto-phagocytosis]] | ||
| Line 113: | Line 111: | ||
* Lack sensitivity | * Lack sensitivity | ||
|- | |- | ||
|Anti-Ro/SSA antibodies | |Anti-Ro/SSA 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" | | ||
| Line 120: | Line 117: | ||
* 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" | | ||
| Line 127: | Line 123: | ||
* More commonly associated with [[Sjögren's syndrome|Sjögren’s syndrome]] | * More commonly associated with [[Sjögren's syndrome|Sjögren’s syndrome]] | ||
|- | |- | ||
|Anti-U1 RNP antibodies | |Anti-U1 RNP 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" | | ||
| Line 157: | Line 152: | ||
|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|rheumatoid arthritis (RA)]] | ||
* Higher specificity for [[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]] | * Consider [[RA]] | ||
|- | |- | ||
| Line 171: | Line 166: | ||
|- | |- | ||
| | | | ||
* Serologic testing for [[Hepatitis|hepatitis B virus (HBV)]] and [[Hepatitis C virus|hepatitis C virus (HCV)]] | * [[Serology|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]] | * [[Serology|Serologic]] studies for [[borrelia]] | ||
** Especially in areas endemic for [[lyme disease]] | ** Especially in areas endemic for [[lyme disease]] | ||
|- | |- | ||
| Line 184: | Line 179: | ||
| | | | ||
* 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: | ||
** [[Mixed connective tissue disease|MCTD]] | ** [[Mixed connective tissue disease|MCTD]] | ||
** [[Polymyositis|Polymyositis (PM)]] | ** [[Polymyositis|Polymyositis (PM)]] | ||
| Line 210: | Line 205: | ||
|30 | |30 | ||
| - | | - | ||
|Renal, neurologic, vasculitis and hematologic | |[[Renal]], [[Neurology|neurologic]], [[vasculitis]] and [[hematologic diseases]] | ||
|- | |- | ||
|snRNP (U1 RNP) | |snRNP (U1 RNP) | ||
| Line 230: | Line 225: | ||
|20 | |20 | ||
| - | | - | ||
|Neuro-psychiatric disease, [[liver disease]] | |[[Neuropsychiatry|Neuro-psychiatric]] disease, [[liver disease]] | ||
|- | |- | ||
|RF | |RF | ||
Revision as of 05:41, 26 July 2017
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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.
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]
General laboratory changes during SLE flares
| Lab exam | result | clinical correlation | ||
|---|---|---|---|---|
| Hematology | Complete blood count |
| ||
| Serum creatinine | Elevated |
| ||
| Amylase | Elevated |
|
||
| Lipase | ||||
| Urine | Urinalysis |
|
| |
| Urine sediment | ||||
| Serology | ANA | Elevated |
| |
| Antiphospholipid antibodies[5] |
|
| ||
| Complement levels[6] |
|
| ||
| 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[7] | Elevated |
| ||
| Anti-La/SSB antibodies[7] | Elevated |
| ||
| Anti-U1 RNP antibodies[7] | 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.
- ↑ 7.0 7.1 7.2 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.