JAMA Clinical Reviews Diagnosis and Treatment of Systemic Lupus Erythematosus
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Apr 8, 2024 Caroline H. Siegel, Assistant Professor of Medicine and rheumatologist focused on lupus research. She defines who gets lupus and typical signs like rashes and joint pain. She walks through initial tests and how diagnosis is made. She reviews first-line therapy hydroxychloroquine, newer drugs for nephritis and nonrenal disease, and the role and risks of steroids and cardiovascular and cancer associations.
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Lupus Is A Highly Variable Systemic Disease
- Systemic lupus erythematosus (lupus) is a systemic autoimmune disease that can affect nearly any organ and varies widely between patients.
- It most commonly presents from late adolescence through the sixth decade and is more frequent in women and Black, Asian, and Hispanic people.
Screen For Lupus With CBC CMP And ANA
- For suspected lupus in primary care, order CBC, basic metabolic panel, and an antinuclear antibody (ANA) as the initial screen.
- If ANA is positive in context, refer to rheumatology rather than reflexively ordering extensive autoantibody panels.
Interpret ANA By Titer And Clinical Context
- ANA is highly sensitive but not specific; specificity increases with higher titers.
- Classification criteria use a titer threshold of 1:80, but clinical context matters and low titers require ruling out other causes.