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Medical Author:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Catherine Burt Driver, MD

Catherine Burt Driver, MD

Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

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Most often lupus is evaluated and treated in the doctor's office. Rheumatology is the field of medicine that is dedicated to autoimmune diseases such as lupus. A rheumatologist is an expert in evaluating and treating lupus.

Criteria for diagnosing lupus

The diagnosis of lupus is a clinical one made by observing symptoms. Lab tests provide only a part of the picture. The American College of Rheumatology has designated 11 criteria for classification. Keep in mind that not all patients suspected of having lupus meet these criteria. To be classified as having lupus accordingly, a person must have four or more of these criteria:

• Malar rash: This is a "butterfly-shaped" red rash over the cheeks below the eyes. It may be a flat or a raised rash.
• Discoid rash: These are red, raised patches with scaling of the overlying skin. A subgroup of patients have "discoid lupus" with only skin involvement and do not have systemic lupus erythematosus. All patients with discoid lupus should be screened for systemic involvement.
• Photosensitivity: A rash develops in response to sun exposure. This is not to be confused with heat rash that develops in body folds or moist areas of the body with exposure to heat.
• Oral ulcers: Painless sores in the nose or mouth need to be observed and documented by a doctor.
• Arthritis: The arthritis of lupus usually does not cause deformities of the joints. Swelling and tenderness must be present.
• Serositis: This refers to an inflammation of various "sacs" or membranes that cover the lung, cover the heart, and line the abdomen. Inflammation of these tissues causes severe discomfort in the areas affected.
• Kidney disease (nephritis): There is persistent loss of protein in the urine, or a microscopic analysis of the urine, demonstrates inflammation of the kidneys. This can be demonstrated when microscopic analysis of urine has a particular cellular element referred to by pathologists as a "cast."
• Neurological disorder: This can present as seizures or as a primary psychiatric disorder.
• Blood disorder: Low blood counts of various blood components are known to occur.
• Immunologic disorder: This requires special laboratory testing for specific markers of disease in lupus. These tests include antibodies to DNA, a nuclear protein (Sm), or phospholipids (which includes the falsely positive test result for syphilis/RPR, cardiolipin antibodies, and lupus anticoagulant). The presence of these and other antibodies that can react with the body's own tissues is why lupus is called an autoimmune disease.
• Positive antinuclear antibody: A more general marker in the blood for the presence of an autoimmune disease, these "ANA" levels increase with age, thereby somewhat increasing the rate of an incorrectly positive test as a person gets older. The ANA test is most useful when the result is negative, which essentially rules out the diagnosis of SLE, since up to 98% of people with lupus have a positive ANA test result.

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