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Thread: Questions about Diagnosis

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    Default Questions about Diagnosis

    Hi All!
    I have not been diagnosed with Lupus, but I've got some symptoms and a high ANA. I am wondering if you can get diagnosed only with these two factors, or if other blood/urine tests have to be abnormal to make it technically Lupus? So far my other blood tests and my urine test have shown up normal. But I have symptoms that I think could be related to Lupus. Please tell me if the other tests are crucial for diagnosis, and if any of these symptoms sound similar to your experience:

    -ANA 1:640
    -Tired, weak, fatigued often
    -Morning stiffness in my ankles, back, etc.
    -Muscle cramping in the back of one leg daily
    -Hands hurt--to type, etc.
    -Get sick easily (always sick the week before my period)
    -Red rash on my face (doc says looks like Lupus rash, didn't respond to rosacea meds)
    -High temp--used to be regularly 96 or 97, now more like 99
    -Get super itchy in the sun, get little red bumps on my legs
    -TMJ (had surgery for it when I was 18 )
    -Sometimes anemic, but sometimes not...so strange
    -Diahrrea, sometimes
    -Abdominal pain often
    -Chest pain/pain right near my left armpit, with my arm going numb, fingers going tingly, fingers swelling up and wedding ring feelign super tight
    -Can't cry sometimes (no tears come out), can't wear contacts more than a few hours
    -Canker sores often
    -Bumps on my scalp that are sometimes painful
    -2 miscarriages (8 & 10 weeks)
    -1 pre-term baby (26 weeks gestation)
    -1 pregnancy that, with cerclage & bed rest, went to 36 wks, but had strong contractions & shots to stop labor each week, and had protein in my urine throughout pregnancy

    Please let me know if these symptoms sound similar to those of Lupus, and also if the other tests are crucial for diagnosis. Thank you!!

    Brenda

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    Hi Brenda;

    In 1982, the American Rheumatism Association published a revised set of criteria to aid physicians in making the diagnosis of Lupus. The criteria (see note) are:
    Malar Rash
    Discoid Rash
    Photosensitivity
    Oral Ulcers
    Arthritis
    Serositis
    Renal disorder
    Neurologic disorder
    Hematological disorder
    Immunologic disorder
    Positive fluorescent antinuclear antibody (FANA) or ANA test result
    A physician observing a person to have at least 4 out of the 11 criteria, either serially or collectively, should be suspicious to the possibility of lupus being the underlying disorder. However, physicians must also be careful in utilizing criteria for an individual case, as other diseases could also conform to the criteria. Presently, the diagnosis of lupus is usually based on these findings:
    evidence of a multi-system disease (more than one organ involved):
    the presence of autoantibodies;
    the exclusion of other diseases and disorders which can mimic the features of lupus.

    lupus still remains a very difficult disease to diagnose. Two reasons account for this difficulty: 1)There is no single set of symptoms that are uniformly specific to lupus. 2)There are no laboratory tests yet available that can prove conclusively that a person has or does not have lupus. Also, almost every symptom of lupus can also be easily attributed to other illnesses or disorders. In addition, the symptoms are sometimes vague or they may come and go spontaneously. For instance, fever, weight loss,
    marked fatigue and weakness which are often experienced by someone with lupus, may also be symptoms of many others disorders, some more threatening, some less so.
    Also, if temporary joint or muscle pain is the initial problem, here again there are so many causes of such symptoms that it may be very difficult to link these to lupus. If pleurisy is a symptom and it spontaneously clears up rather quickly, then it might be assumed that a virus was the cause and not necessarily lupus.
    Often it can take years for the diagnosis to be made. Doctor's will want to determine if you are showing symptoms or clinical evidence of a multi-system disease (i.e. abnormalities in several different organ systems such as is seen in Lupus). The following are typical manifestations (symptoms) which might lead to suspicion of SLE:
    Skin: butterfly rash; ulcers in the roof of the mouth; hair loss.
    Joints: pain; redness and swelling.
    Kidney: abnormal urinalysis suggesting kidney disease.
    Lining membranes: pleurisy; pericarditis and/or peritonitis (taken together this type of inflammation is known as polyserositis).
    Blood: hemolytic anemia (the red cells are destroyed by autoantibodies);
    leukopenia (low white blood cell count);
    thrombocytopenia (low platelets).
    Lungs: infiltrates that may be transient.
    Nervous system: convulsions (seizures); psychosis; nerve abnormalities that cause strange sensations or alter muscular ability.

    The second diagnostic principle is to examine the status of the immune system in individuals having a suspicious clinical history. In general, physicians now look for evidence of autoantibodies. Some commonly used tests of immune status in the diagnosis of SLE are:
    The anti-nuclear antibody test (ANA): a test to determine if autoantibodies to cell nuclei are present in the blood.

    The anti-DNA antibody test: to determine if the patient has antibodies to the genetic material in the cell.

    The anti-Sm antibody test: to determine if there are antibodies to this substance, a nuclear protein.

    A variety of tests for the presence of immune complexes in the blood.

    Tests to examine the total level of serum complement - a group of proteins involved in the inflammation which can occur in immune reactions - and tests to assess the specific level of C3 and C4, two proteins of this group.

    LE cell prep: An examination of the blood looking for a certain kind of cell which has ingested the swollen antibody-coated nucleus of another cell.
    A positive ANA may occur sometime during the course of the illness in about 90 percent of patients with SLE, but it also occurs in a variety of other illnesses and in as much as 5 percent of the normal population. It is a very sensitive test and is now more frequently performed than the LE prep.

    I hope that I have answered some of your questions. Let me know if you need anything further.

    Peace and Blessings
    Saysusie

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