Diagnosing lupus

Diagnosing lupus

When should you see a doctor?

Doctor performing a physical exam on a young man with enlarged lymph nodes.

Severe complications from lupus can happen quickly in many instances, and will require immediate medical assistance (escalating to an emergency).

Life-threatening signs can include those of a heart attack (chest pain or pressure, profuse sweating, shortness of breath, nausea and vomiting, a fast or irregular heartbeat, pain or pressure in the back, neck, jaw, upper abdomen and one or both shoulders or arms, as well as light headedness and sudden weakness), or stroke (sudden numbness, tingling or weakness, paralysis, vision changes, seizure, difficulty with speaking or understanding speech, or sudden nausea, vomiting, headache or dizziness).

Consult your doctor as soon as possible if you:

  • Experience shortness of breath
  • Have blood in your urine, begin urinating less often or notice smaller amounts than usual
  • Have a high fever (with or without a headache or body aches typical of flu, but you haven’t likely been exposed to a virus)
  • Experience unexplained changes in behaviour or thinking, and depression
  • Have tingling sensations or numbness in your hands and feet
  • Experience dizziness and muscle weakness
  • Notice any swelling in your lower legs and or / feet
  • Develop any new symptoms of lupus

Who should you see?

  • A general practitioner (GP), rheumatologist or immunologist can help assess initial symptoms or treat mild cases of lupus.
  • A rheumatologist or immunologist can also assist with the long-term management of more severe or complex lupus cases.
  • Other specialists that are consulted as needed include psychiatrists (for mental health problems), cardiologists, dermatologists, haematologists, nephrologists, neurologists, and pulmonologists who can all treat vital organ problems caused by lupus.

Diagnosis and tests

Before making a diagnosis, your doctor or specialist will likely ask some very specific questions. Diagnosing lupus is particularly difficult as signs and symptoms can vary considerably from person to person, may vary over a period of time or even overlap with those of other disorders.

Questions you may be asked will be:

  • Have you ever experienced skin rashes after being out in the sun?
  • Have you noticed that your fingers become pale, numb, uncomfortable or tingle, especially during cold weather?
  • Do you experience any symptoms that include problems with concentration or memory?
  • Do any of your symptoms limit your ability to function normally at work, school or in your personal relationships?
  • Are you aware of or have you been diagnosed with any other medical conditions?
  • Are you pregnant? Do you plan to become pregnant?

If lupus is suspected, a combination of tests may be discussed with you. No single test can currently diagnose lupus. Following a physical exam, your doctor may suggest a combination of blood and urine tests.

Blood and urine tests will assess the following:

  • A complete blood count: Anaemia is a strong indication of lupus. Your doctor will measure the number of red blood cells, white blood cells, platelets and the amount of haemoglobin (a protein in the red blood cells) with this blood test.
  • The erythrocyte sedimentation rate: This blood test will be used to measure the rate at which your red blood cells settle to the bottom of a tube within a period of an hour. A faster than normal rate indicates a systemic condition (like lupus), but isn’t specific to any one disease or another. An elevated or faster rate can indicate any other inflammatory condition, cancer or infection.
  • Kidney and liver assessment: This blood test looks at how well your kidneys and liver are functioning, and whether lupus may be affecting these organs negatively.
  • Urinalysis: A urine sample will be taken to assess whether there is an increased protein level or presence of red blood cells in the urine. This test usually ties in with the blood test assessing your kidney function. If lupus is affecting your kidneys, it will be evident in the results of this test.
  • Antinuclear antibody test (ANA): This test will assess the presence of antibodies, produced in the immune system, which may indicate a stimulated immune system. A positive ANA result may prompt your doctor to conduct more specific antibody testing. A positive result isn’t enough to determine lupus – many with a positive result are diagnosed with lupus, while others aren’t.

Other tests include:

  • Imaging tests: If your doctor suspects any lung or heart damage, a chest X-ray (assessment of any abnormal shadows suggesting possible fluid or inflammation on the lungs) or echocardiogram (use of sound waves to produce real-time images of your beating heart, and assess any problems with the valves and other portions of the heart) test will be suggested.
  • Biopsy: A small sample of organ tissue (such as the kidneys) may be taken to determine the type and extent of damage that may have occurred. This will then help your doctor determine what the best course of treatment may need to be. A needle may be used to extract this sample. Alternatively, a small incision may be required.
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