Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis.
Blood and urine tests may include:
- Complete blood count. Results may indicate you have anemia, which commonly occurs in lupus. A low white blood cell or platelet count may occur in lupus as well.
- Erythrocyte sedimentation rate. The sedimentation rate isn’t specific for any one disease. It may be elevated if you have lupus, another inflammatory condition, cancer or an infection.
- Kidney and liver assessment. Blood tests can assess how well your kidneys and liver are functioning. Lupus can affect these organs.
- Urinalysis. An examination of a sample of your urine may show an increased protein level or red blood cells in the urine, which may occur if lupus has affected your kidneys.
- Antinuclear antibody (ANA) test. A positive test for the presence of these antibodies — produced by your immune system — indicates a stimulated immune system. While most people with lupus have a positive ANA test, most people with a positive ANA do not have lupus. If you test positive for ANA, your doctor may advise more-specific antibody testing.
If your doctor suspects that lupus is affecting your lungs or heart, he or she may suggest:
- Chest X-ray. An image of your chest may reveal abnormal shadows that suggest fluid or inflammation in your lungs.
- Echocardiogram. This test uses sound waves to produce real-time images of your beating heart. It can check for problems with your valves and other portions of your heart.
Lupus can harm your kidneys in many different ways, and treatments can vary, depending on the type of damage that occurs. In some cases, it’s necessary to test a small sample of kidney tissue to determine what the best treatment might be. The sample can be obtained with a needle or through a small incision.
Medicines can’t cure lupus, but they can control many symptoms and often can prevent or slow organ damage.
Medicine treatment for lupus often involves reaching a balance between preventing organ damage, having an acceptable quality of life, and minimizing side effects.
If you have mild disease or symptoms that affect your quality of life but you don’t have organ-threatening problems, your doctor may prescribe:
- Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), sometimes in combination with antimalarial drugs. Acetaminophen and NSAIDS are often enough to reduce symptoms.
- Antimalarial drugs such as hydroxychloroquine (Plaquenil).
- Low-dose corticosteroids and/or corticosteroid creams or ointments.
If you have more severe disease, your doctor may prescribe:
- Corticosteroids, such as prednisone.
- Immunosuppressive medicines, such as azathioprine, belimumab, cyclophosphamide, methotrexate, or mycophenolate mofetil.
If you have had blood clots in a vein or artery (venous or arterial thrombosis), or have antiphospholipid antibody syndrome, which increases your risk for blood clots, your doctor may prescribe a blood thinner (anticoagulant). This is especially important if you already have blood clots. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that is sometimes used to slow blood clotting in antiphospholipid antibody syndrome.