Lupus (Systemic Lupus Erythematosus) Health (cont.)

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When to Seek Medical Care

When to call the doctor

Call your health care professional if you experience

  • high fever;
  • unusual headache;
  • blood in the urine;
  • chest pain;
  • shortness of breath;
  • swelling of the legs;
  • weakness of the face, arms, or legs, on one side;
  • unusual abdominal pain;
  • unusual joint pain;
  • recurrent pregnancy loss (miscarriages);
  • visual disturbances.

When to go to the hospital

Go to the hospital if you experience

  • fever greater than 102 F,
  • rapidly decreasing urine volume,
  • chest pain,
  • sudden onset or unusual shortness of breath,
  • sudden onset of weakness,
  • severe headache,
  • sudden changes in vision,
  • acute onset of abdominal pain,
  • inability to bear weight or move a swollen joint due to severe pain,
  • rapid swelling of one or more extremities (arms, legs, hands, or feet).

Lupus Diagnosis

Most often lupus is evaluated and treated in the doctor's office. Rheumatology is the field of medicine that is dedicated to autoimmune diseases such as lupus. A rheumatologist is an expert in evaluating and treating lupus.

Criteria for diagnosing lupus

The diagnosis of lupus is a clinical one made by observing symptoms. Lab tests provide only a part of the picture. The American College of Rheumatology has designated 11 criteria for classification. Keep in mind that not all patients suspected of having lupus meet these criteria. To be classified as having lupus accordingly, a person must have four or more of these criteria:

  • Malar rash: This is a "butterfly-shaped" red rash over the cheeks below the eyes. It may be a flat or a raised rash.
  • Discoid rash: These are red, raised patches with scaling of the overlying skin. A subgroup of patients have "discoid lupus" with only skin involvement and do not have systemic lupus erythematosus. All patients with discoid lupus should be screened for systemic involvement.
  • Photosensitivity: A rash develops in response to sun exposure. This is not to be confused with heat rash that develops in body folds or moist areas of the body with exposure to heat.
  • Oral ulcers: Painless sores in the nose or mouth need to be observed and documented by a doctor.
  • Arthritis: The arthritis of lupus usually does not cause deformities of the joints. Swelling and tenderness must be present.
  • Serositis: This refers to an inflammation of various "sacs" or membranes that cover the lung, cover the heart, and line the abdomen. Inflammation of these tissues causes severe discomfort in the areas affected.
  • Kidney disease (nephritis): There is persistent loss of protein in the urine, or a microscopic analysis of the urine, demonstrates inflammation of the kidneys. This can be demonstrated when microscopic analysis of urine has a particular cellular element referred to by pathologists as a "cast."
  • Neurological disorder: This can present as seizures or as a primary psychiatric disorder.
  • Blood disorder: Low blood counts of various blood components are known to occur.
  • Immunologic disorder: This requires special laboratory testing for specific markers of disease in lupus. These tests include antibodies to DNA, a nuclear protein (Sm), or phospholipids (which includes the falsely positive test result for syphilis/RPR, cardiolipin antibodies, and lupus anticoagulant). The presence of these and other antibodies that can react with the body's own tissues is why lupus is called an autoimmune disease.
  • Positive antinuclear antibody: A more general marker in the blood for the presence of an autoimmune disease, these "ANA" levels increase with age, thereby somewhat increasing the rate of an incorrectly positive test as a person gets older. The ANA test is most useful when the result is negative, which essentially rules out the diagnosis of SLE, because most people with lupus have a positive ANA test result.
Medically Reviewed by a Doctor on 5/8/2014

Patient Comments

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Lupus - Symptoms Question: The symptoms of lupus can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Lupus - Treatments Question: What treatments have been effective for your lupus?
Lupus - Experience Question: Please describe your experience with lupus.
Lupus (Systemic Lupus) - Prevention Question: What prevention measures do you use to avoid getting lupus flares?

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