How is lupus diagnosed? In clinical practice, the determination of Lupus is usually made taking into account the combination of symptoms and immunological alterations of the disease.
The different forms of presentation of Lupus and the multiplicity of clinical characteristics during its evolution make its diagnosis complicated.
The confirmation diagnosis of Lupus will require the presence of suggestive symptoms that affect two or more organs or systems. After the presence of these symptoms, the health professional will proceed to perform blood tests that will help confirm or rule out this disease.
How is lupus diagnosed?
Obtaining a diagnosis can be difficult and can take months or years. This difficulty is because the manifestations necessary to establish the diagnosis do not usually occur simultaneously but instead, appear over time.
To get a diagnosis, your doctor should consider:
- Your medical history.
- A complete examination.
- Blood tests.
- Biopsy of the skin or kidneys.
Lupus is an example of a multisystem disease. It is essential that multidisciplinary teams share their management. These teams must be led and coordinated by doctors with training, experience, and specific dedication to autoimmune diseases, which in Spain are mostly rheumatologists or internists. Also, depending on the type of particular manifestations in each patient, the participation of other specialties may be necessary:
- Obstetricians and gynecologists
The involvement of primary care physicians and their adequate coordination with hospital physicians are also significant. Likewise, it is increasingly involved in the care of patients with Lupus nurses, psychologists, physiotherapists, social workers …
It is essential that the work of different professionals is coordinated, as well as ensuring easy accessibility and rapid response in situations of need from the patients.
Symptoms of Lupus
What are the symptoms of Lupus? Lupus presents a wide variety of symptoms, as well as a very variable evolution and prognosis. In general, Lupus is presented as a mixture of muscular, joint, skin or hematological symptoms and of the immune system, to which general symptoms such as fatigue or fever are added.
There are patients in whom Lupus manifests itself through the involvement of specific organs (the kidney or the brain, for example). In general, the symptoms that dominate during the first years of the disease tend to continue later.
The following are the symptoms that can be presented by Lupus, both at the beginning and in the evolution of the disease:
Fever, fatigue, and weight loss are the so-called “general symptoms” that are present in most patients with Lupus.
The most frequent are:
Arthritis (inflammation of the joints) and arthralgias (joint pain). More than 90% of patients present any of these two symptoms throughout the course of the disease.
Affectation of skin and mucous membranes. It occurs in 60% of patients at the beginning of the disease and up to 80% in the course of the disease. Among them and in order of the frequency they manifest:
Malar erythema It is the most characteristic symptom of Lupus and consists of inflammation and redness of the nose and cheeks, which can cause pain, burning sensation, and tight skin. It usually appears in the shape of a butterfly and is generally related to sun exposure. Other forms of skin disease are discoid lupus (chronic and scarring), subacute lupus, or other varied skin rashes. Alopecia or significant hair loss (especially on the scalp).
Ulcers or canker sores (open and painful sores) in the mouth. Purple (purple spots on the skin) and hives, although they are much less frequent.
Raynaud’s phenomenon. A prevalent symptom, especially at the beginning of the disease, which is characterized by the presence of pallor, numbness, and coldness in the fingers. Sometimes the fingers can go from white to blue. Once the episode is over, the blood circulates again, the fingers become red, and there is a tingling sensation of stinging or burning.
Renal disease. It occurs in 50-70% of patients. The kidney becomes inflamed, loses protein (proteinuria), and may not adequately remove waste from the body, so it accumulates in the blood.
Neuropsychiatric involvement and cerebrovascular manifestations
It usually appears in the first years of the disease (28% of patients with Lupus). The most frequent neuropsychiatric symptoms are headaches, depression, seizures, anxiety and decreased cognitive functions (orientation, language, memory …).
On the other hand, the cerebrovascular disease usually presents, in particular, thromboembolic (presence of a blood clot or ” thrombus,” which obstructs the flow of blood to certain parts of the brain). Only 1 in 3 people, the presence of these symptoms can be directly attributed to Lupus.
Pulmonary manifestations. In the course of Lupus pleuritis (inflammation of the membrane covering the lungs), interstitial pneumonitis (inflammation with scarring of the lungs) and pulmonary hypertension (higher than normal pressure in the arteries of the lungs)may occur.
The last two are infrequent, but pleuritis occurs in 50% of patients with Lupus throughout the disease, although it is rare to appear at the onset of the disease. These symptoms usually present as chest pain accompanied by difficulty breathing.
They are common in patients with Lupus but are usually more associated with the treatment than with the disease itself. They emphasize gastritis (inflammation or swelling of the lining of the stomach) and the peptic ulcer (sore in the mucosa that covers the belly), related to the non-steroidal anti-inflammatories and the glucocorticoids.
They present at the beginning of the disease in 23% of patients; However, during Lupus, they can affect 80% of patients. Among the most frequent hematological manifestations is the decrease in the number of white blood cells, followed by a reduction of red blood cells (anemia) and platelets (thrombocytopenia).
This syndrome is associated with the presence of thrombi (blood clots) in arteries and veins. In pregnant women, it is usually associated with complications such as repeated miscarriages, fetal deaths, premature births, and preeclampsia (a severe form of pregnancy-induced hypertension).
Now, you clear how is lupus diagnosed. The symptoms described tend to appear and disappear. When the symptoms appear, they are called “buds.” The outbreaks vary from mild-moderate to strong. At any time, new symptoms may appear.