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How is lupus diagnosed and monitored

During the past thirty years, more sensitive blood tests have allowed us to recognise that for every patient with severe lupus, there are many more with subtle forms of the disease where the diagnosis is delayed or missed.

Blood tests are used both for confirmation as well as for monitoring the progress of the illness. The ANA (antinuclear antibody) test, if positive, should be followed by other specific tests to pinpoint more accurately the extent and type of the disease.

Main tests in lupus:

  • Anti-nuclear antibodies ("screening test")
  • Anti-DNA antibody ("specific" for lupus) 
  • Anti-cardiolipin antibody (clotting tendency)
  • Lupus anticoagulant (clotting tendency)
  • (ESR) erythrocyte sedimentation rate 
  • (CRP) C-reactive protein 
  • Routine blood count & chemistry
  • Complement 
  • Urine

Many patients, when first told they have lupus find information scarce and often full of gloom. Until recent years, lupus was widely regarded by doctors as a rare disease - sometimes as a dire disease, involving kidney damage and a fatality rate. They may have advised their patients against pregnancy at all cost and issued other alarming warnings.

However, the real prognosis is good. Iindeed in the majority of patients, the disease can be brought under control and many patients are able to come off most of their medication when the disease goes into remission after a few years.

 

For over two decades, the American College of Rheumatology (ACR) criteria for the classification of lupus have provided the benchmark for clinico-pathological surveys worldwide and have stood the test of time.