3 Anti-Smith antibodies are uncommon but specific for lupus and associated with nephritis and cytopenias. 2 More specific for lupus is the presence of anti-double-stranded DNA antibodies, particularly when detected by the radionucleotide Farr assay. These are observed in approximately 70% of patients with lupus. However, they are nonspecific and present in approximately 5% of the healthy population at titres of 1:320. Almost all patients (99%) have antinuclear antibodies at diagnosis. The variable manifestations of lupus make diagnosis difficult and serology can be useful ( see Box). * For a positive diagnosis, patients must have 4 or more of the listed criteria, with at least 1 clinical and 1 laboratory criterion Positive Direct Coombs test – in the absence of haemolytic anaemia Thrombocytopenia – in the absence of other causesĪnti-dsDNA antibodies – above reference range (or >2-fold if tested by ELISA)Īntiphospholipid antibodies – positive lupus anticoagulant, false-positive rapid plasma reagin test, medium- or high-titre cardiolipin antibody, positive anti-b2-glycoprotein Leucopenia – in the absence of other causes Haemolytic anaemia – in the absence of other causes Neurological symptoms – seizures, psychosis, mononeuritis multiplex, myelitis, peripheral or cranial neuropathy, acute confusional state Renal involvement – urine protein:creatinine ratio or 24-hour urine protein with >500 mg protein/24 hours or red cell casts Serositis – typical pleurisy for more than one day, pleural effusions, pleural rub or typical pericardial pain for more than one day, pericardial effusion, pericardial rub or pericarditis by ECG
Non-scarring alopecia – in the absence of other causesĪrthritis – synovitis involving 2 or more joints, characterised by swelling or effusion or tenderness in 2 or more joints and at least 30 minutes of morning stiffness Oral or nasal ulcers – palate, buccal, tongue, or nasal in the absence of other causes Acute cutaneous – lupus malar rash, bullous lupus, toxic epidermal necrolysis variant of lupus, maculopapular lupus rash, photosensitive lupus rashĬhronic cutaneous – discoid lupus rash, hypertrophic (verrucous) lupus, lupus panniculitis, mucosal lupus, lupus erythematosus tumidus, chilblains lupus, discoid lupus
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