The Curbsiders Internal Medicine Podcast #171 Lupus in Primary Care with Beth Jonas MD
Sep 9, 2019
Beth Jonas MD, academic rheumatologist and chief of rheumatology at UNC, explains when to suspect lupus and which history and exam clues matter. She covers practical lab strategies like ANA and ENA testing, when to escalate to nephrology, and first-line treatments and lifestyle measures. Short, clinical, and focused on what primary care clinicians should watch for and act on.
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Episode notes
Classification Criteria Are Not Diagnosis
- Classification criteria are designed for clinical trials, not bedside diagnosis.
- Jonas notes the 2019 ACR/EULAR criteria increase sensitivity for early disease but shouldn't replace clinical judgment.
When To Order An ANA
- Order an ANA only when you have a clear clinical suspicion of autoimmune disease.
- Beth Jonas advises checking organ-specific signs (eg painless oral ulcers, hematuria, synovitis) before sending ANA to avoid false alarms.
Start With Minimal Tests For Suspected Lupus
- Do a focused minimal initial workup for suspected lupus: CBC, urinalysis, and TSH if low suspicion.
- Beth Jonas says normal CBC and urinalysis let you watch and avoid premature serologies.
