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Lupus 101


The lupus diagnostic tools of a medical professional can be divided into three major parts:

  • Medical history
  • Complete physical examination
  • Laboratory tests

Your rheumatologist will ask you questions and should do a physical examination (I would recommend your using a pain diary or journal to help your doctor understand your symptom timeline).

Various test need to be preformed for a diagnosis of Lupus.

A complete blood count is done to check your level of red cells, white cells, or platelets, (cells that help control bleeding or clotting.)

If your doctor thinks you may have lupus, other blood tests will determine if you have types of antibodies found in the blood of almost all people with lupus.



The immunofluorescent anti-nuclear antibody (ANA, or FANA): is a test to determine if autoantibodies to nuclei are present in the blood.

ANA reports include a titer (number) and a pattern.

Titer tells how many times the technician had to dilute your blood plasma to get a sample free of anti-nuclear antibodies. Each dilution involves doubling the amount of test fluid. A titer of 1:640 would indicate a greater concentration of anti-nuclear antibodies than a titer of 1:320.

The test can even be weakly positive in healthy individuals. The majority of these people will never develop any signs of lupus or related conditions. The chances of a person having a positive ANA test also increases as he or she ages.

So a titer of 1:640 shows a greater concentration of anti-nuclear antibodies than a titer of 1:320 . A positive titer of between the reference ranges norms of 1:80 and 1:160 is considered by most laboratory test to be in a normal range.

The ANA titers go up and down during the course of lupus or a mixed connective tissue diseases and a high or low titer does not mean the disease is active.

You can't determine the severity of disease or disease activity from ANA titer.


The homogeneous (smooth) pattern is found in a variety of connective tissue diseases (...A heterogeneous group of diseases which tends to affect specialized groups of tissues, bone or organs. A homogeneous pattern may also be found in patients taking particular drugs.

The speckled pattern cell can be found in patients with lupus or connective tissue diseases.

The peripheral (or rim) ANA pattern is found almost exclusively in SLE.

The nucleolar pattern, a pattern with a few large spots , is found in patients who have scleroderma. (An autoimmune disease that affects the blood vessels and connective tissues characterized by thickening and hardening of the skin.)

An ANA test is not conclusive on its own.


Usually a Complement blood test is also ordered.  Complement proteins are identified by the letter 'C' and a number, the most common complement tests being C3, C4, and CH50.  The classic pathway complement function markers of your immune system are Complement C3 and C4.

Complement is a blood protein that destroys bacteria and helps control inflammation.  Your doctor is looking for evidence of a chronic, inflammatory disorder of the immune system.

Complement C4 can be deficient in anywhere from 11% to 80% in the population with Systemic Lupus Erythematosus compared to 1% of the general population with a C4 deficiency .

If your blood complement values are4 levels are low (immune complex processing), AND you also have a positive ANA, weight is added to the diagnosis of lupus.

Low C3 and C4 serum levels in individuals with a positive ANA could also signify the presence of lupus nephritis ( kidney disease) to your doctor.  Blood chemistry tests can help determine whether organs are functioning normally.

Other blood tests may be done for diagnosis and as an aid in following disease activity, so be ready for test then more test.



Erythrocyte sedimation rate (ESR) also known as Sed rate.  Usually an elevated ESR is an indication of inflammation.

Other ususal autoantibody test are the anti-DNA, antiSm, anti RNP, anti-Ro(SSA, anti-La (SSB) .

Besides blood chemistries you may also have a urinalysis and there may also be x-rays.

If kidney involvement or discoid (skin) lupus is suspected, a biopsy may be performed where a small piece of kidney tissue or affected arm tissue is removed and examined.

If the lung involvement is suspected a chest X-ray may be taken.

An echocardiogram may be done to help determine any heart involvement.

An EKG or MRI may be done if the brain or central nervous system is involved or to give an indication of which internal systems may be involved.



Lupus is an unpredictable disease.  Signs of the disease appear and disappear, sometimes for no apparent reason. Lupus is unique. Because lupus assumes so many different forms and is different for each person you may undergo other tests too.  For your doctor to find a correct diagnose takes time and often more tests!

 I'm neither a medical doctor or an immunopharmacologist this is just my understanding of those tests.



Over 1,000,000 Americans have Lupus.* 
Lupus is a chronic, inflammatory disorder of the immune system that affects several body systems at the same time. **

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