No single laboratory test can definitely prove or disprove SLE. Initial screening includes a complete blood count (CBC), liver and kidney screening panels, laboratory tests for specific autoantibodies (e.g., antinuclear antibodies(ANA), a syphilis test (VDRL), urinalysis, blood chemistries, and erythrocyte sedimentation rate (ESR).
Abnormalities in these test results will guide further evaluations.
High-titer anti-nDNA antibody or anti-Sm antibody are important indications of lupus.
Specific immunologic studies, such as those of complement components (e.g., C3 and C4) and other autoantibodies (e.g., anti-La and anti-Ro), are sometimes used to help evaluate the patient's immune status or to monitor the activity of the disease.
At times, biopsies of the skin or kidney using immunofluorescent staining techniques can support a diagnosis of SLE.
A variety of laboratory tests, X rays, and other diagnostic tools are used to rule out other pathologic conditions and to determine the involvement of specific organs.
Psychosocial Aspects of Lupus
Physicians and other health care professionals should be aware of the psychosocial issues involved in treating patients with lupus.
Issues may range from patient frustration during the diagnostic process to family stresses to feelings of isolation and depression.
Lupus' chronic pattern of flares and remissions presents constant challen'es for patients.
It is important for health professionals to show empathy and help their patients develop effective coping skills and identify resources for support throughout the course of treatment.
The goals for treating a patient with lupus include:
- Reducing tissue inflammation caused by the disease
- Suppressing immune system abnormalities that are responsible for tissue inflammation
- Preventing flares and treating them when they do occur
- Minimizing complication
Medications are an important aspect of the management of many patients with SLE. An array of drug therapies is now available, which has increased the potential for effective treatment and excellent patient outcomes. (See below for information on classes of drugs commonly used to treat SLE.)
Following are classes of drugs commonly used to treat SLE:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are useful in treating joint pain and swelling and muscle pain. They may also be used to treat pleuritic chest pain. An NSAID may be the only drug needed to treat a mild flare; more active disease may require additional medications.
These drugs are effective in controlling lupus arthritis, skin rashes, mouth ulcers, fatigue, and fever. They have also been shown to be effective in the treatment of DLE. Antimalarials are not used to manage more serious, systemic forms of SLE that affect the organs.
SLE patients with symptoms that do not improve or who are not expected to respond to NSAIDs or antimalarials may be given a corticosteroid. Although corticosteroids have potentially serious side effects, they are highly effective in reducing inflammation, relieving muscle and joint pain and fatigue, and suppressing the immune system. They are also useful in controlling major organ involvement associated with SLE.
These drugs are also used in serious, systemic cases of lupus in which major organs such as the kidneys are affected or in which there is severe muscle inflammation or intractable arthritis.
Consideration of adverse effects, contraindications, and safety during pregnancy and lactation should be taken in selecting which drug or combination of drugs will be used to treat the patient. Many different methods of improving lupus treatment are currently being researched
Other key issues in treating patients with lupus include:
Lupus flares, miscarriage or stillbirth, pregnancy-induced hypertension, neonatal lupus.
Increased risk of respiratory tract, urinary tract, and skin infections; opportunistic infections.
Weight changes; poor diet; appetite loss; problems with taking medications; increased risk of cardiovascular disease, diabetes, osteoporosis, and kidney disease.
Adapted primarily from "Lupus: A Patient Care Guide for Nurses and Other Health Professionals" (National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH)