Lupus Center of Excellence

Diagnosing Lupus

To diagnose lupus, doctors look for physical or laboratory evidence of the condition, such as swelling of joints, protein in the urine, fluid around the lungs or heart, or a skin biopsy that shows evidence of the disease.

Lupus is often considered the "great imitator," since many diseases can mimic lupus symptoms. Examples include fibromyalgia, thyroid disease, infections, rheumatoid arthritis, and a host of other conditions.

Typically, four or more of the following criteria must be present to make a diagnosis of systemic lupus.

• Face rash, called a malar rash, that is butterfly shaped and covers the bridge of the nose and spreads across the cheeks
• Scaly rash, called a discoid rash, that appears as raised, scaly patches
• Sun-related rash, that appears after exposure to sunlight
• Mouth sores, which are usually painless
• Joint pain and swelling that occurs in two or more joints
• Swelling of the lining around the lungs or the heart
• Kidney disease
• A neurological disorder, such as seizures or psychosis
• Low blood counts, such as low red blood count, low platelet count, or a low white cell count
• Positive antinuclear antibody tests, which may indicate an autoimmune disease
• Other positive blood tests that may indicate an autoimmune disease, such as a positive double-stranded anti-DNA test, positive anti-Sm test, positive anti-phospholipid antibody test, or false-positive syphilis test

Signs and symptoms of lupus may change over time and overlap with those of many other disorders. The doctor may also order blood and urine tests to determine the diagnosis.

Treatment for Lupus

While there is no cure for lupus, early diagnosis and treatment can help patients manage the symptoms and lessen the chance of permanent damage to organs or tissues. Because lupus is different for every person, UPMC lupus experts administer treatments and medications based on individual needs. Determining whether signs and symptoms should be treated and which medications to use requires a careful discussion of the benefits and risks.

Some of the common medications used to treat lupus include:

Non-steroidal anti-inflammatory medications (NSAIDs)

• Agents such as naproxen, ibuprofen, or meloxicam help most patients control symptoms, such as rashes and joint pain.
• Should be used cautiously because of the risk of bleeding gastric ulcers and kidney disease.

Prednisone (steroid/cortisone)

• One of the most frequently used medicines to control common symptoms of lupus.
• Many patients require a low dose of prednisone to control their lupus over the long-term.
• High doses may be used to treat severe "flares" of lupus.
• Because steroids have many side effects, physicians often need to use other agents to help reduce the daily dose.
• Dermatologists may prescribe steroid creams or ointments for rashes caused by lupus.

Hydroxychloroquine (Plaquenil)

• Reduces the complications and prevents "flares" of lupus.
• Most doctors will recommend indefinite or lifelong treatment of hydroxychloroquine to control symptoms of lupus that involve the skin, hair, joints, and fatigue.

Methotrexate (MTX)

• Often used to treat people with rheumatoid arthritis.
• Found to also help people with lupus manage joint paint and rashes.

Azathioprine
(Imuran)

• Useful for blood involvement, serositis, and kidney disease caused by lupus.

Mycophenolate mofetil (Cellcept)

• Primarily used for kidney disease caused by lupus.
• Often used for more serious manifestations of lupus.

Cyclosphosphamide
(Cytoxan)

• Primarily used to treat the central nervous system and kidney involvement caused by lupus.
• Occasionally used to treat lung disease caused by lupus.

Rituximab

• Primarily used to treat kidney and brain disease caused by lupus.
• Can also treat severe systemic involvement in lupus.

Belimumab (Benlysta)

• The latest drug approved for the treatment of lupus.
• May be used after other medications have been tried and failed to achieve success.

Aspirin/Warfarin (Coumadin, blood thinners)

• Often used in patients who may be prone to stroke and blood clots in the lungs and lower extremity.

Other important components of lupus therapy include supportive care and counseling, treatment for depression and anxiety, use of sunscreen to protect against "flares," treatment for associated fibromyalgia, and pain management.

Each of these complex treatments requires regular blood work and disease monitoring to ensure their safety and efficacy.  Lupus patients should be seen by a lupus expert or rheumatologist every three to four months to assess disease activity and to help control any ongoing symptoms and monitor for drug side-effects.