During the past thirty years, more sensitive blood tests have allowed us to recognise that for every patient with severe lupus, there are many more with subtle forms of the disease where the diagnosis is delayed or missed.
Blood tests are used both for confirmation as well as for monitoring the progress of the illness. The ANA (antinuclear antibody) test, if positive, should be followed by other specific tests to pinpoint more accurately the extent and type of the disease.
Main tests in lupus:
Anti-nuclear antibodies ("screening test")
Anti-DNA antibody ("specific" for lupus)
Complement
Anti-cardiolipin antibody (clotting tendency)
Lupus anticoagulant (clotting tendency)
(ESR) erythrocyte sedimentation rate
(CRP) C-reactive protein
Blood count & chemistry
Urine
It should be noted that the blood tests are not infallible and it is really important to also take a full medical history and examine the patient carefully. For example, patients with discoid lupus alone often have a negative ANA. Patients early in the disease course may have negative autoantibody tests which later become positive.
If symptoms are persistent or progressive, it is worth re-evaluating the patient and repeating the blood tests.
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Many patients, when first told they have lupus find information scarce and often full of gloom. Until recent years, lupus was widely regarded by doctors as a rare disease - sometimes as a dire disease, involving kidney damage and a fatality rate. They may have advised their patients against pregnancy at all cost and issued other alarming warnings.
However, the real prognosis is good. Indeed in the majority of patients, the disease can be brought under control and many patients are able to come off most of their medication when the disease goes into remission after a few years.
With careful planning, pregnancy is usually possible, although all lupus patients will need careful monitoring during pregnancy. Click here to read more on pregnancy and lupus.
