By A. G. Moore
Many diseases are difficult to diagnose. One of these is systemic lupus. There is no protocol for diagnosing lupus that is entirely objective. To a great extent, the diagnosis and treatment of lupus depends on the treating physician’s skill and experience. Thus, a patient may consult three doctors and from each receive a different interpretation of symptoms and medical tests. Until the underlying cause of lupus is better understood, this imprecise and sometimes harmful diagnostic process will continue.
A survey of journal articles reveals a complex variety of lupus symptoms. (See an article at the Lupus Foundation of America’s site: Diagnosing Lupus). Lupus has been described as a disease with a thousand faces–I think it may have more than that.
Four years passed between the time my first lupus symptoms appeared and the time I was ultimately diagnosed. In some cases, diagnosis may take as long as ten years. New manifestations of this disease are being discovered all the time.
The American College of Rheumatology (ACR) has tried to create some objective guidelines for doctors who treat lupus. Rheumatologists (systemic lupus is considered a rheumatological disease) depend upon a list of eleven ACR criteria to help them decide if a patient has lupus. These criteria were developed for research purposes and not clinical practice. Thus, the ACR has warned, if doctors rely exclusively on the criteria for diagnosis, some patients who have lupus are likely to be overlooked.
Doctors, however, are trained to think systematically, and the criteria give them a framework within which to organize clinical impressions. So, for the most part, the ACR list has become the lupus diagnostic bible.
The ACR periodically reviews and revises its “bible”. For example, Raynaud’s Disease used to be on the list but is no longer included. If four of the ACR elements are present, a doctor can feel justified in concluding that a patient has lupus.
The list includes the following elements:
- Malar rash, which is generally raised and spreads across the nose and cheeks almost in the shape of a butterfly.
- Anti-nuclear antibodies, or a positive ANA.
- A discoid rash, which occurs most commonly on the scalp and face and which is scaly, raised and appears in patches.
- Photosensitivity, which results in a rash after exposure to sunlight
- Two or more joints that are swollen and painful.
- Mouth sores, usually painless
- Serositis – an inflammation of the heart, lung or gut lining.
- Kidney disease
- Psychosis, seizure or other indication of a neurological disorder.
- Reduced numbers of certain parts of the blood, such as platelets, white blood cells or red blood cells.
- Some laboratory tests which indicate abnormal immune system function. These include double-stranded DNA (highly indicative of lupus), anti-Smith (found in virtually no other disease) and anti-phospholipid.