Table 5.

Diagnostic Tools for Lupus

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Medical history: Focus in the skin rashes, butterfly rash over the cheeks and nose, migraine, nausea (feeling sick) or joint pains. The joints
may even become tender to the touch and swollen. This is one of the most common and certainly one of the most prominent features of
lupus. Patients often describe it as an unnatural fatigue. Its causes are not well understood. Often it precedes the diagnosis by months or
years and only when treatment has been successfully started does the patient realize how major a feature it had been. The majority of lupus
patients suffer at some stage from joint and muscle pains. In many patients this presents as pain all over. In acute flares of lupus the
symptoms are often described as being flu-like. Unlike other rheumatic diseases such as rheumatoid arthritis, there is often very little to
see in the way of joint swelling. It is not just the joints that are affected but the tendons and muscles as well. In the majority of cases the
joint inflammation does not progress to permanent damage.
Complete physical examination:, focus in skin rashes, loss of hair, edema and erythema of the joints, chest pain at the end of taking a deep
breath, shortness of breath, cough and ankle swelling,
Laboratory tests:
1. Complete blood count (CBC): The complete blood count or CBC test is used as a broad screening test to check for such disorders as
anemia, infection, and many other diseases.
2 .Erythrocyte sedimentation rate (ESR) also called a sedimentation rate or Biernacki Reaction, is the rate at which red blood cells sediment
in a period of 1 hour.
3. Urinalysis
4. Blood chemistries.
Complement levels: A low level of complement could mean the substance is being used up because of an immune response in the body,
such as that which occurs during a flare of lupus.
5. ANA Test
6. Other autoantibody tests (anti-DNA, anti-Sm, anti-RNP, anti-Ro [SSA], anti-La [SSB])
7. Anticardiolipin antibody test
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Skin biopsy: take a 4 microns punch and embed in formalin 10% and other of similar size embed in Michels medium for direct
immunofluorescence.
Kidney biopsy: Any consideration of the benefits of kidney biopsy must include knowledge of the risks of the procedure. With improved
imaging and the use of semi-automated biopsy guns, complications are uncommon. However, bleeding remains of foremost concern.
Major complications, those requiring blood transfusion or invasive intervention, have been reported in 06.4% of biopsies. Predictors of
complications have included low haematocrit and high creatinine. Patients with SLE may have an additional risk of bleeding due to
concurrent corticosteroid use or platelet dysfunction, though this has not been studied. Suggested indications for performance of a kidney
biopsy in lupus nephritis: 1) Acute renal failure indicated by a rising creatinine, 2) Urine protein >500mg per 24h or urine protein:
creatinine ratio >0.5g protein/g creatinine. 3) Haematuria in the presence of any level of proteinuria. 4) Presence of red and/or white cell
casts (cellular casts).5) Failure to respond adequately to therapy or relapse after therapy.

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