Healthy Living

How Is Lupus Diagnosed?

How Lupus is Diagnosed

Key Takeaways

  • Lupus is a chronic inflammatory disorder that develops when your organs and tissues are attacked by your own immune system.
  • It can be hard to diagnose lupus since its signs and symptoms are similar to those of other conditions. 
  • Lupus is diagnosed according to blood tests, symptoms, and physical evaluation. 

Lupus is a chronic inflammatory disorder that develops when your organs and tissues are attacked by your own immune system. Lupus causes inflammation in numerous body organs such as the heart, skin, blood cells, joints, lungs, brain, and the kidneys.

It can be quite hard to diagnose lupus since its signs and symptoms are similar to those of other conditions. A facial rash that looks like butterfly wings, specifically on the two cheeks is a unique sign of lupus. Although not all people with lupus experience this sign, it is very common.

Certain individuals are naturally prone to lupus. A few drugs, infections, and even sunlight can trigger lupus symptoms. Although lupus has no cure, its symptoms can be controlled by treatments. However, the majority of lupus symptoms resemble those of other conditions and can appear and disappear over the course of a few months. It may even take years to successfully diagnose lupus.

Lupus symptoms

For lupus to be diagnosed, the doctor needs to have laboratory results or physical proof of the ailment such as proteinuria (having protein in the urine), swelling of the joints, and fluid surrounding the heart or lungs. These health conditions indicate that lupus is present.

The butterfly rash or malar rash, which is also known as acute cutaneous lupus is one of the four types of lupus related to the skin. Malar is derived from the Latin word “mala”, which would mean "cheekbone". Malar rash is a medical indication of a characteristic type of facial rash. A butterfly-shaped rash across the cheeks is the most visible sign of lupus. It could develop suddenly or it could appear after sunlight exposure. About 50 percent of people with lupus have a butterfly rash. The rashes on the cheeks are mostly red or purple in color, which can appear in a blotchy pattern or appear as completely red that covers the affected area. The area can be flat or slightly raised in nature.

The butterfly rash of lupus is typically painless and does not itch. However, at times, the rash can cause itchiness if it appears more like a rash rather than a blush. There have been some instances wherein patients have complained of a “hot” feeling when the malar rash becomes severe. Along with inflammation of other organs, the butterfly rash of lupus can be triggered by photosensitivity, which is a condition worsened by exposure to sunlight.

The rash gets it name because it resembles a butterfly, which spans the width of the face, covering both cheeks and bridge of the nose. The butterfly rash may appear on its own, but some people observe that the appearance of the butterfly rash is a sign of an oncoming disease flare. Whatever the case, it is important to pay attention to the body’s signals and notify the doctor of anything unusual. Studies have revealed that malar rash is mostly seen in people who are suffering from a type of lupus known as systemic lupus erythematosus (SLE).

The body’s immune system is mainly affected by lupus. The immune system usually generates proteins known as antibodies that guard your body from unfamiliar invaders. The immune system of people with lupus is unable to differentiate between the healthy body tissues and the foreign invaders. Autoantibodies that destroy healthy tissues are then produced. As a result of these autoantibodies, there is pain, inflammation, and damage in the different parts of the body.

Doctors usually look for signs of inflammation such as redness, pain, swelling, and heat. Inflammation can take place outside of the body, on the skin, or in the heart and kidneys.

Lupus is diagnosed according to blood tests, symptoms, and physical evaluation. Other conditions can also be ruled out by specific tests.

Causes 

It is not yet clearly identified as to what exactly causes lupus. However, studies indicate that the development of lupus is a response to a variety of factors that would involve both the inside and outside of the human body. Factors include genetics, hormones, or the environment.

1) Genetics

There is no specific gene or group of genes known to be the cause for lupus. The prevalence of lupus is known in some families and certain genes, which have been identified as a contributing factor for the development of this medical condition. Moreover, there are chances of lupus on individuals with no family history of such condition. Africans, Native Americans, Asians, or Hispanics are known to be at a greater risk of developing lupus.

2) Hormones

Hormones are chemical substances produced by the body. They are known to regulate or control the activity of specific cells or organs. Lupus is mostly seen as a common occurrence in females than men. Studies say that women experience lupus symptoms just before their menstrual periods or during pregnancy when the production of estrogen levels are high in the body.

3) Environment

Studies indicate that there are certain environmental agents such as virus or chemicals that could trigger the occurrence of lupus in an individual. Some of those triggers would be in the form of infections, colds, ultraviolet rays, exposure to silica, stress, exhaustion, injury, or smoking.

Symptoms 

The following are the most common symptoms of lupus:

You will probably not experience all lupus symptoms. The majority of individuals with lupus only have the leading symptoms. Less common symptoms of lupus include:

  • High body temperature
  • Swollen lymph glands 
  • Frequent mouth ulcers 
  • Hypertension (high blood pressure)
  • Abdominal pain
  • Memory loss
  • Migraines and headaches
  • Depression
  • Feelings of confusion
  • Edema or swelling in the leg, ankles, or around the eyes
  • Seizures
  • Pleuritis
  • Leukopenia
  • Myocarditis
  • Anemia
  • Chest Pain
  • Psychosis (inability to differentiate between imagination and reality)
  • Breathlessness
  • Raynaud's disease (poor supply of blood to the feet and hands during cold times)

Diagnosing lupus

A lupus diagnosis takes into account a number of factors since the condition can resemble other ailments. They include:

  • Complete medical history of the person – It is important that you inform your doctor regarding your past health issues and the medications you have taken.
  • Signs and symptoms – A complete medical evaluation including analyzing all your current symptoms.
  • Results of the physical evaluation
  • Analysis of tests that are linked to the status of the immune system – Additionally, your doctor may order several tests to help confirm if you suffer from an autoimmune condition.
  • Analysis of standard laboratory test results

Lupus can be diagnosed through various blood tests. The following are laboratory tests for the diagnosis of lupus:

1) ANA (antinuclear antibody) test

Approximately 95 percent of individuals who have lupus are ANA-positive. However, the results can at times turn out positive in individuals who do not have the condition. Thus, a lupus diagnosis cannot be confirmed using this type of test.

2) Anti-dsDNA (anti-double stranded DNA) test

Approximately 70 percent of individuals with lupus possess these antibodies. Since it is rare for the test to turn out positive in individuals without lupus, a positive result will signify that there is a high probability of lupus. The level of anti-dsDNA normally rises when lupus is very active. Hence, it can be beneficial to have recurring tests as a way of observing the condition and settling on the appropriate treatment.

3) Anti-Ro antibody test

If this test turns out to be positive, you will have high chances of developing skin rashes and will experience dry mouth or dry eyes. During pregnancy, this autoantibody can go through the placenta. Your pregnancy will be watched strictly if you have the anti-Ro autoantibody, especially if you decide to carry the pregnancy to term.

4) Antiphospholipid antibody test

If you test positive for these autoantibodies, you will be more prone to developing blood clots or miscarriages.

5) Complement test

Complement proteins are contained in the blood and guard your body against infectious attacks. When lupus is very active, the level of complement goes down.

6) ESR (Erythrocyte sedimentation rate)

The assessment of inflammation can be done by calculating how fast the blood cells reach a test tube’s bottom. In lupus, the ESR is mostly raised.

7) Liver and kidney function tests

These tests involve routine blood and urine examinations to identify and immediately deal with any complications arising from lupus treatments. The presence of blood or protein in the urine can be identified in a urine test. A urine test will assist in the early detection of kidney complications. If there is a need for additional tests, a test for kidney filtration may be performed. A biopsy is the most effective method for determining the degree of kidney damage. It may be recommended for individuals with kidney test irregularities.

8) Blood cell counts

Red and white blood cells, platelets, and hemoglobin are produced in the bone marrow. Therefore, blood cell counts can assist in determining if there is damage in the bone marrow, caused either by medications for treating the disease or the disease itself.

After the diagnosis, these tests can help in observing the disease. For instance, a blend of dropping complement levels and a high anti-dsDNA levels can be used to forecast lupus breakouts. When the CRP is raised, your doctor will look for a probability of an infection.

To know the condition of your liver, heart, spleen, and lungs, you can have a wide range of tests. A CT scan, MRI, ultrasound, or X-ray may be performed depending on the organs in question. It is important that you head in for regular checkups, and get your body scanned regularly, since it can help you identify any key issues, and allow you to take effective measures in treating the same.

If you experience symptoms such as a persistent lymph gland swelling, weight loss, and fever, a biopsy may be recommended to ensure you have no cancer, which can also be the origin of the previously mentioned symptoms.

Your doctor may recommend the following if he or she thinks that your heart or lungs are being affected by lupus.

1) Echocardiogram - is a test that generates instantaneous pictures of your beating heart using sound waves. It can look for issues with the valves and other areas of the heart.

2) Chest X-ray - an image of your chest that shows irregular shadows can imply an inflammation or fluid in the lungs.

Kidney biopsy

The kidneys can be affected by lupus in various ways. Treatments can differ according to the type of kidney damage. At times, there will be a need to check the kidney tissues to decide on the appropriate treatment. Through a tiny cut, a needle is used to obtain a sample. The sample is then tested to gauge the right treatment to use and to treat the underlying condition effectively.

What to Ask After a Lupus Diagnosis

You may have numerous questions when your doctor tells that you have lupus. To guide you through it, below are some questions that will help you acquire the necessary information for a better understanding of your symptoms, management of the disease, and treatment of your condition. Knowing the details will help you relax, thereby accelerating the treatment process. Bringing someone close to you may be wise to assist you in keeping the crucial information in mind.

While lupus can affect you mentally, you should know that there are millions of people over the world who suffer from the same condition. Moreover, the condition can be managed with the right medication as well as changes to your lifestyle and diet.

1) What can I do to manage the symptoms?

Lupus can affect any part of your body. Although lupus may have an emotional impact on you, the condition is nevertheless manageable as long as you take a few precautions. For starters, opt for a healthy diet, since it can provide your body with the required vitamins and proteins needed to ward off any infections.

Try adding more greens to your regular diet. Stock up on whole grains and food items rich in omega-3 and omega-6 fatty acids. A healthy diet can help you keep the bad cholesterol down while providing your body with the good fat, the sort that you need to help you avoid infections.

2) How will my body be affected by lupus?

The condition can cause you to develop mouth ulcers, skin rashes in all body parts, eczema, and other skin conditions. Apart from skin problems, lupus can also cause other health issues, from joint pain to developing chronic fatigue. The latter can impact your normal day-to-day functioning, and even cause muscle atrophy.

It can also cause sudden hair loss, as well as numb extremities causing your fingers and toes to turn blue. It can cause sudden weight loss as well. 

3) Will the kidney or other important organs in the body be affected by the disease?

Since lupus is an autoimmune disease, it can affect any organs in the body including your kidneys. It can cause your kidneys to function abnormally due to inflammation. If it is left untreated, lupus can cause your kidney to shut down completely. Thus, it is always a good idea to seek medical consultation and regular checkups to properly monitor your condition.

4) Is it okay to get pregnant?

Lupus comes with its own risks, but women can get pregnant and carry their unborn child to "full-term" as long as they take necessary care and appropriate medication. 

5) What treatment options are available and what are their possible side effects?

Most lupus medications can come with their own range of side effects. However, such side effects are manageable when addressed early on. The medicines used to treat lupus symptoms are powerful enough to cause stomach bleeding, liver problems, and even develop kidney disease.

Drugs used to treat malaria can also be used for lupus. The side effects associated with such medications often range from an upset stomach to retinal issues, although the latter is rare. Corticosteroids can go a long way to alleviating lupus symptoms, but they can also cause bruising, high blood pressure, diabetes, and bone thinning.

The severity of these side effects depends more on the dosage and duration of treatment.

6) Can you recommend any specialists in the treatment of lupus?

Doctors who specialize in joint and muscle diseases can help diagnose lupus. They are called as rheumatologists or pediatric rheumatologists (for children and adolescents). An allergist/immunologist may also be consulted to assess your body's immune response.

7) How regular should I go for checkups?

If you are diagnosed with lupus, then you need to go in for regular checkups and have a complete body health checkup once every few months. Doing so can help you and your physician to monitor your health better and know if the impact of the current treatment for lupus is effective or not.

8) Are there any available treatment alternatives for lupus?

While conventional treatment may be the preferred method to treat lupus, you can always opt for a few herbal remedies. But a better approach would be to start eating healthy and to avoid eating foods rich in trans fats, sugar, and sodium.

Try eating organic food, one that’s completely unprocessed as it can help keep the inflammation down. Additionally, eating vegetables rich in proteins and antioxidants such as legumes can help you combat lupus effectively.

Consuming fiber-rich food should help your body absorb the nutrients more effectively. It can help keep the inflammation from lupus down. Moreover, try to include fish and avocado as part of your regular diet since they can help moisturize your skin while lowering body inflammation as well.

Natural Remedies for Lupus

1) Anti-inflammatory food

Having a healthy diet is important to people who are diagnosed with lupus. A healthy diet can help control inflammation that is caused by poor gut health. In addition, having a healthy diet can lower the risk of developing complications such as heart disease. It lessens the side effects of medications and helps build energy and strength.

The recommended foods for people with lupus include organic and unprocessed foods, raw vegetables, fish, high-antioxidant foods, and bone broth. Drinking plenty of fluids and taking coconut or olive oil are also beneficial. Apart from these, there are certain foods that can provide relief from skin dryness and irritation, which are very common in lupus. These foods help moisturize the skin from inside and out. They include avocado, melon, cucumbers, olive oil, coconut oil, walnuts, almonds, chia seeds, and flaxseeds.

An individual suffering from lupus should avoid certain foods that could worsen their condition. Such foods include gluten-enriched foods, sugary products, caffeinated drinks, alcohol, salty foods, and foods with trans fat and saturated fats.

2) Regular exercise

Doing regular physical activities can help a person recover from lupus flares, helps fight depression, lowers the risk of a heart attack, and promote an optimal well-being. Regular exercise also promotes good sleeping pattern, makes the lungs and heart stronger for better functioning, strengthens the bones, reduces pain in the joints, and reduces any health-related complications. However, one should start it slowly without exerting too much pressure on any part of the body. Overexertion is always harmful and can worsen one's existing medical condition. It is also important to give yourself enough rest in between the workouts so the muscles can buildup and recover again from the physical strain. The exercises that are considered as beneficial for people suffering from lupus are swimming, brisk walking, yoga, cycling, Pilates, and aerobics.

3) Adequate rest

People with lupus often experience fatigue or tiredness. Their level of fatigability is much higher compared to normal people. Thus, having plenty of sleep at night and getting naps during the day are important.

4) Reducing stress

Emotional and psychological stress often lead to lupus flare-ups that can worsen the lupus condition. There are different kinds of stress relievers suited for different people. Yoga, meditation, and acupuncture have given numerous benefits in the health of the immune system. One can also practice breathing techniques, praying, and exercising to keep stress at bay.

5) Protecting the skin

There is one type of lupus called the cutaneous lupus erythematosus, which is known to create a wide variety of dermatologic signs and symptoms. Due to the inflammatory response, skin rashes are prone to occur in lupus. Hence, it is very important to protect the skin from certain irritants. Take precautionary measures by:

  • Avoiding direct exposure to the sun
  • Applying non-toxic sunscreen lotions
  • Always wear sun glasses 
  • Wearing protective clothes if you need to be out in the sun
  • Avoiding hot showers during summer 
  • Taking the recommended vitamins for lupus

Risk or Complications

Lupus can also lead to certain complications if the treatment is not carried out on time:

Pregnancy

Pregnant women with lupus have an increased risk of miscarriage. Lupus is known to increase the risk of high blood pressure during the pregnancy period. Hence, to avoid such instances and to reduce the risks, doctors often suggest delaying the pregnancy until the medical condition is under control with the help of treatment for at least a period of six months.

Infections

Lupus is known to impair the immune system, thereby causing a rise of infections. The medical condition and its treatment are both known to increase the risk of having a weak immune system. Infections that would most commonly affect people suffering from lupus are yeast infections, urinary tract infections, respiratory infections, herpes, or shingles.

Avascular necrosis (AVN)

AVN is also known as bone tissue death, wherein the supply of blood to the bone starts reducing. It gradually leads to tiny breaks or cracks in the bone leading to a collapse of the bone structure. The most commonly affected area is the hip joint.