Evaluation of SLE
Evaluation of the Systemic lupus erythematosus (SLE) is started from the detail history and significant physical finding. The detail history will involve the symptoms and the impact of the symptoms that affect the patient’s life as a whole. Severity of the symptoms should be assessed.
Presence of antinuclear antibodies (ANA) is a cardinal feature (6) of laboratory investigation (Refer Table 2). It is important to bear in mind that although ANA sensitive, it is not specific for SLE. Extensive laboratory assessment should include full blood count (FBC), ESR, complements level 3 and 4 (C3 and C4), complement CH50, serum immunoglobulins, VDRL (to look for syphilis), PTPTT (coagulation profile), anticardiolipin (aCL) antibody, lupus anticoagulant, ANA and subtypes. These subtypes are consists of antibodies to dsDNA, ssDNA, Sm, Ro, La and histone. Urinalysis should be done to look for any evidence of hemolysis (6).
Evidence showed that antinuclear antibody is helpful in screening test because it is found in 96.2% of SLE’s patients (5). Surprisingly, a study published in 1995 shows 95% patients with SLE have positive ANA (10). It means that the percentage of ANA positivity is not much change since the last 10 years. The problem is ANA is sensitive, but not specific. As a contrary, Anti-double stranded DNA and anti-Smith antibodies which are highly specific for SLE but not sensitive. Both these antibodies are included in SLE criteria as produced by ACR. Anti-dsDNA (antibody for double stranded DNA) is found in 29.1% while anti-SmB (anti smith B autoantibody) found in 28.1% of patients (5).
Other investigations are appropriate radiographic studies of affected joints and ECG. Renal biopsy should be considered in patient with evidence of glomerulonephritis. Diagnosis is made in the presence of 4 or more out of 11 published criteria’s of the classification of SLE.
Table 2: Frequency (%) of laboratory abnormalities in Systemic Lupus Erythematosus.
| Anemia | 60% |
| Luekopenia | 45% |
| Thrombocytopenia | 30% |
| Biologic false positive tests for syphilis | 25% |
| Antiphospholipid antibodies | |
| Lupus anticoagulant | 7% |
| Anticardiolipin antibody | 25% |
| Direct coomb’s positive | 30% |
| Proteinuria | 30% |
| Hematuria | 30% |
| Hypocomplementemia | 60% |
| ANA | 95-100% |
| Anti-native DNA | 50% |
| Anti smith | 20% |
Source: McPhee, SJ. and Papadakis, MA. Current Medial Diagnosis & Treatment. Forty Eight Edition. New York: McGraw Hill; 2009
Other related articles:
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- Clinical manifestations of SLE
- Evaluation of SLE
- Criteria for the classification of SLE
- Management of SLE
- SLE and in vitro fertilization (IVF)
- SLE and oral contraceptive pills (OCP)
- Lifestyle modification and health promotion is SLE
- Role of primary healthcare in SLE
- Overall view of SLE
Reference:
- Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison’s principle of internal medicine. Manual of medicine, 16th edition, International edition, editors.Mc Graw Hill.2005
- Hoffman, EA, Meheus L, Huizinga TWJ, Cebecauer, L, Isenberg, D, De Bosschere, K. et al. Specific antinuclear antibodies are associated with clinical features in systemic lupus erythematosus. Annals of the Rheum Dis. 2004;63:1155-1158.
- Belilos E, Carsons SE. Systemic lupus erythematosus: Recognition and management by the primary care physician . Primary Care Update for OB/GYNS.1995;2(2):80-84.
Tags: antinuclear antibody, history, lupus anticoagulant, physical examination, SLE
Technorati Tags: antinuclear antibody, history, lupus anticoagulant, physical examination, SLE
My daughter passed away in February from a Lupus related illness. We tried many varying treatments and diets, but also worked closely with her doctor and specialist.
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