Lupus is an inflammatory autoimmune disease that presents differently across patients. Because symptoms are not consistent from patient to patient, and symptoms also overlap with those of other diseases, lupus is difficult to diagnose.
American College of Rheumatology’s “Eleven Signs of Lupus”
Symptoms are varied among lupus patients. Therefore, to help physicians diagnose lupus, the American College of Rheumatology defined eleven different potential signs of lupus. If an individual displays at least four without explanation by the presence of any other disease or condition, then the individual is suggested to have lupus. These symptoms are evaluated through physical exams and laboratory tests.
- Malar rash: This rash is known as the “butterfly rash.” It spreads across the cheeks and nose.
- Discoid rash: This rash spreads across the skin in patches with raised red bumps.
- Photosensitivity: The skin is abnormally sensitive to sunlight. Following sun exposure, a rash spreads across the skin.
- Mouth or nose ulcers: These sores are usually painless, but they can “pulse.” Sometimes medication side effects include mouth sores.
- Nonerosive arthritis in two or more joints: This type of arthritis does not damage the bones in joints. Rather, joint pain occurs as a result of swelling, fluid effusion, and inflammation.
- Cardio-pulmonary inflammation: The lining of the heart (“pericardium”) and lungs (“pleura”) become inflamed in conditions known as pericarditis and pleuritis, respectively. Chest pain is a sign of pericarditis and pleuritis, as inflammation can cause scarring of the heart and lung tissue.
- Neurological disorder: It is possible to experience seizures and/or psychosis. These conditions tend to come and go, and they are usually completely reversible.
- Renal disorder: Lupus can damage the kidneys of some patients. This causes inadequate blood filtration in the kidneys. Renal disorder can be detected because if kidney function is not optimal, protein is excreted in the urine.
- Hematologic disorder: Blood cell count can dip in patients with lupus, leading to signs of anemia, poor blood clotting, and inadequate immune function. This is detected using a complete blood count, which measures the number of red blood cells, white blood cells, and platelets.
- Immunologic disorder: Autoimmunity in lupus can produce antibodies to double stranded DNA and proteins essential to normal cell function.
- Antinuclear antibodies (ANAs): Detecting ANAs in the absence of certain drugs can indicate lupus. Most lupus patients have a positive test for ANAs, but most people with a positive test for ANAs do not have lupus. Therefore, more specific follow-up tests are necessary.
When an individual meets three or fewer of the eleven criteria, the patient is said to have “borderline lupus.” Physicians may also refer to this state as “incomplete lupus” or “undifferentiated lupus.” Some patients within this population develop additional criteria within the next five years and are diagnosed with lupus, but those patients are in the minority. Most “borderline lupus” patients never develop additional lupus symptoms and are instead diagnosed with a different condition.
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