Lupus Diagnosis and Treatment

Lupus diagnosis and treatment can be complicated.

A 2016 LupusChick research study, in conjunction with Clark University and researcher Maria Mongiardo, interviewed over 2,000 patients whose average time span between initial symptoms and diagnosis was six years. This is because Lupus symptoms come and go, and mimic many other diseases. For this reason, Lupus is called the “great imitator”.

Likewise, there is no set treatment for Lupus, as it affects every person in a different way. Depending on the symptoms and organ-involvement experienced, a patient could undergo a variety of treatments that help with a multitude of symptoms.

Lupus Diagnosis

Achieving a diagnosis usually consists of blood tests and a physician reviewing your symptoms, in addition to doing a physical exam and ruling out other diseases.

Rheumatologists — a type of medical specialist that oversees Lupus patients — use a set of eleven criteria to determine if lupus is the culprit. If a patient has four or more of the symptoms, then Lupus might be suspected. Note that the symptoms do not have to occur at the same time. 

LUPUS CRITERIA:

1. Butterfly Rash—A rash that can extend over the nose to the cheeks.
2. Discoid Rash—This is a thicker rash that is usually raised and can scar, especially on sun-exposed areas.
3. Photosensitivity—This is a rash that occurs after being exposed to sunlight.
4. Oral Ulcers—These ulcers can occur in the nose or the mouth and are usually recurring.
5. Arthritis—An Inflammation of two peripheral joints, usually occurring with tenderness and swelling.
6. Serositis—This is an inflammation of the lung lining, known as Pleuritis, or an inflammation of the heart lining, known as Pericarditis.
7. Disorders of the Kidney—Proteins found in the urine or abnormal sediments found in the urine (these can be seen under a microscope).
8. Neurologic Disorders—Convulsions or Seizures or Psychosis that occurs in the absence of drugs that are known to cause these conditions.
9. Abnormalities in the Blood—Hemolytic Anemia, Low White Blood Cell counts, or Low Platelet counts.
10. Immunologic Disorders—Blood tests that indicate Lupus anticoagulant, anti-DNA, false-positive syphilis test, positive anti-Sm or antiphospholipid antibodies.
11. Positive ANA (Antinuclear Antibodies)—Blood Test in the absence of drugs known to induce it.

Nearly all people with lupus have a positive test for antinuclear antibody (ANA). However, having a positive ANA alone does not mean you have lupus. ANA has been the most widely accepted test as an indicator for Lupus, but there have been advancements in testing in recent years.

In 2018, Exagen released their AVISE® CTD test, which tests for lupus and a wide variety of other connective tissue diseases with a high degree of accuracy. Since many doctors do not yet know about this test, it’s important that patients do their research and discuss their options with their diagnosing physician.

Lupus Treatment

Treatments vary between patients, as there are different types of Lupus, and it is said no two cases are alike. 

Depending on symptoms and the severity of Lupus, treatment may include:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are usually your run-of-the-mill over-the-counter drugs like Aleve, Ibuprofen, and Advil. These medications are a major factor in some Lupus patients’ treatment because, like their name implies, they combat inflammation, which is a major player in Lupus symptoms.

Antimalarial Drugs

Medications commonly used to treat malaria, such as hydroxychloroquine (Plaquenil) or chloroquine (Aralen) have an inhibiting effect on the immune system. At a cellular level, these medications can stop immune cells from triggering an attack on the body’s organs and systems.

Corticosteroids (Steroids)

Prednisone and other types of corticosteroids help reduce the inflammation of Lupus. Some Lupus patients take steroids non-stop for long periods (sometimes years) in order to keep flares of their Lupus from happening.

Immunosuppressants

Immunosuppressants such as azathioprine (Imuran, Azasan), mycophenolate mofetil (CellCept) and methotrexate (Trexall) are prescribed to Lupus patients to help suppress their immune system response. 

Biologics

Biologics are infusion medications Lupus patients get that help suppress or reverse immune system responses in the body. A patient experiencing ongoing or frequent flares may get biologic infusions to help stop them.

Chemotherapy

Most well-known as a treatment for cancer, Lupus patients may also undergo chemotherapy. For severe Lupus cases, chemotherapy is used as an immunosuppressant. It’s typically given in lower doses than that used for cancer treatment. 

Your Diagnosis and Treatment

If you’re currently experiencing Lupus symptoms and in the process of getting diagnosed or undergoing treatment, it’s important that you discuss all of your options with your physician to make sure you’re getting the best care for your particular case. Because no two cases of Lupus are exactly alike, it’s likely that you will have a slightly different experience of Lupus diagnosis and treatment than someone else would.

Continue reading through the in-depth series:

#1: What is Lupus?

#2: The Types of Lupus

#3: Lupus Symptoms

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