Serological diagnosis of systemic lupus

erythermatosis
The diagnosis of systemic lupus erythematosus (SLE) must be

based on the proper constellation of clinical findings and

laboratory evidence

SLE is an autoimmune disorder characterized by antibodies to

nuclear and cytoplasmic antigens, multisystem

inflammation, protean clinical manifestations, and a relapsing

and remitting course. More than 90% of cases of SLE occur in

women, frequently starting at childbearing age

Sensitivity: the ability of a test to correctly identify patients

with a disease. 

Specificity: the ability of a test to correctly identify people

without the disease

Autoantibody Tests for SLE 

Test Description

Screening test; sensitivity 95%; not diagnostic

ANA
without clinical features

High specificity; sensitivity only 70%; level is

Anti-dsDNA
variable based on disease activity

Most specific antibody for SLE; only 30-40%

Anti-Sm
sensitivity

Present in 15% of patients with SLE and

Anti-SSA (Ro) or Anti- other connective-tissue diseases such as 
SSB (La) Sjögren syndrome; associated with 
neonatal lupus
 Uncommon antibodies that may correlate
with risk for CNS disease, including
Anti-ribosomal P increased hazards of psychosis in a large
inception cohort, although the exact role in
clinical diagnosis is debated [108]

Included with anti-Sm, SSA, and SSB in the

ENA profile; may indicate mixed
Anti-RNP
connective-tissue disease with overlap SLE, 
scleroderma, and myositis

IgG/IgM variants measured with ELISA

are among the antiphospholipid antibodies
Anticardiolipin used to screen for antiphospholipid
antibody syndrome and pertinent in SLE
diagnosis
  
IgG/IgM variants measured with ELISA are
 
among the antiphospholipid antibodies used to
Anticardiolipin
screen for antiphospholipid antibody syndrome
and pertinent in SLE diagnosis

Multiple tests (eg, direct Russell viper venom

Lupus anticoagulant test) to screen for inhibitors in the clotting
cascade in antiphospholipid antibody syndrome

Coombs test–positive anemia to denote

Direct Coombs test
antibodies on RBCs

Drug-induced lupus ANA antibodies are often of

this type (eg, with procainamide or hydralazine;
Anti-histone
p-ANCA–positive in minocycline-induced drug-
induced lupus)
ANA = antinuclear antibody; CNS = central nervous system; ds-
DNA = double-stranded DNA; ELISA = enzyme-linked
immunoassay; ENA = extractable nuclear antigen; Ig =
immunoglobulin; p-ANCA = perinuclear antineutrophil cytoplasmic
antibody; RBCs = red blood cells; RNP = ribonucleic protein; SLE =
systemic lupus erythematosus; Sm = Smith; SSA = Sjögren syndrome
A; SSB = Sjögren syndrome B.
In June 2022 the US Food and Drug Administration (FDA) cleared
the EliA Rib-P test (Thermo Fisher Scientific, Waltham MA), a
fluorescence enzyme immunoassay (FEIA) for anti–ribosomal P
antibodies.
References:

https://emedicine.medscape.com/article/332244-workup?
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