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 [[autoantibodies]] elevation of [[ANA]], [[anti-dsDNA antibody]], [[anti-SM antibody]] and [[antiphospholipid antibodies]], and decrease of [[complement]] levels.
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 [[C-reactive protein|CRP]] as [[Acute phase reactant|acute phase reactants]], and positive [[Coombs test|direct coombs test]].


== Laboratory tests ==
== Laboratory tests ==
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!result
!result
!clinical correlation
!clinical correlation
!
|-
|-
| rowspan="4" |Hematology
| rowspan="4" |Hematology
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* Mild [[anemia]]
* Mild [[anemia]]
* [[Thrombocytopenia]]
* [[Thrombocytopenia]]
| colspan="2" |
|
* Non-specific
* Non-specific
* May be related to constitutional symptoms
* May be related to constitutional symptoms
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|[[Serum creatinine]]
|[[Serum creatinine]]
|Elevated  
|Elevated  
| colspan="2" |
|
* Suggestive of [[renal dysfunction]]
* Suggestive of [[renal dysfunction]]
|-
|-
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| rowspan="2" |
| rowspan="2" |
* Acute [[pancreatitis]]
* Acute [[pancreatitis]]
|
|-
|-
|[[Lipase]]
|[[Lipase]]
|
|-
|-
| rowspan="2" |Urine
| rowspan="2" |Urine
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* [[Proteinuria]]
* [[Proteinuria]]
* Cellular casts
* Cellular casts
| colspan="2" rowspan="2" |
| rowspan="2" |
* Suggestive of [[renal dysfunction]]
* Suggestive of [[renal dysfunction]]
|-
|-
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|[[ANA]]
|[[ANA]]
|Elevated
|Elevated
| colspan="2" |
|
* 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
|-
|-
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* [[IgG]] and [[IgM]] [[Anti-cardiolipin antibodies|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" |
|
* Can be predictive of [[hematologic]] and [[Thromboembolic disease|thromboembolic]] involvement
* Can be predictive of [[hematologic]] and [[Thromboembolic disease|thromboembolic]] involvement
|-
|-
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* C4: reduced
* C4: reduced
* CH50: reduced
* CH50: reduced
| 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
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|[[Erythrocyte sedimentation rate|Erythrocyte sedimentation rate (ESR)]]
|[[Erythrocyte sedimentation rate|Erythrocyte sedimentation rate (ESR)]]
|Elevated
|Elevated
| colspan="2" |
|
* Non-specific
* Non-specific
|-
|-
|[[C-reactive protein|C-reactive protein (CRP)]]
|[[C-reactive protein|C-reactive protein (CRP)]]
|Elevated
|Elevated
| colspan="2" |
|
* Non-specific
* Non-specific
|-
|-
|Urine protein-to-creatinine ratio
|Urine protein-to-creatinine ratio
|Elevated
|Elevated
| colspan="2" |
|
* [[Lupus nephritis]]
* [[Lupus nephritis]]
|-
|-
|[[Anti-dsDNA antibody]]
|[[Anti-dsDNA antibody]]
|Elevated
|Elevated
| colspan="2" |
|
* Highly specific for SLE
* Highly specific for SLE
* In 70% of patients
* In 70% of patients
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|[[Anti-SM antibody|Anti-SM antibodies]]  
|[[Anti-SM antibody|Anti-SM antibodies]]  
|Elevated
|Elevated
| colspan="2" |
|
* Highly specific for SLE  
* Highly specific for SLE  
* In 30% of patients
* In 30% of patients
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|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>
|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>
|Elevated
|Elevated
| colspan="2" |
|
* In 30% of patients
* In 30% of patients
* More commonly associated with [[Sjögren’s syndrome]]
* More commonly associated with [[Sjögren’s syndrome]]
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|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>
|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>
|Elevated
|Elevated
| colspan="2" |
|
* In 20% of patients
* In 20% of patients
* More commonly associated with [[Sjögren's syndrome|Sjögren’s syndrome]]  
* More commonly associated with [[Sjögren's syndrome|Sjögren’s syndrome]]  
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|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>
|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>
|Elevated
|Elevated
| 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)
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|Antiribosomal P protein antibodies
|Antiribosomal P protein antibodies
|Elevated
|Elevated
| colspan="2" |
|
* High specificity for SLE & low sensitivity for SLE
* High specificity for SLE & low sensitivity for SLE
* Lack specificity for involvement of a particular organ system or disease manifestation
* Lack specificity for involvement of a particular organ system or disease manifestation
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|
|
* Clinically important in the absence of other causes of hemolytic anemia
* Clinically important in the absence of other causes of hemolytic anemia
|
|}
|}



Revision as of 14:49, 27 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. 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, 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]

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
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[5]
Complement levels[6]
  • 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[7] Elevated
Anti-La/SSB antibodies[7] Elevated
Anti-U1 RNP antibodies[7] 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
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 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

  1. Tan EM (1989). "Antinuclear antibodies: diagnostic markers for autoimmune diseases and probes for cell biology". Adv. Immunol. 44: 93–151. PMID 2646863.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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. 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.

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