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Q&A with Australian Health Practitioners
What is Lupus?
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Dr Dick Beatty
GP (General Practitioner)
Dr Dick Beatty is a Full Time Vasectomist - operating across locations in South East Queensland, including Greenslopes Private Hospital. View Profile
Lupus is really known as Systemic Lupus Erythematous - it is a mouthful and it is known simply as SLE. There are other forms of lupus that affect just the skin such as discoid lupus and subacute cutaneous lupus, and these would usually be diagnosed on a skin biopsy with or without blood tests. The diagnosis and skin biopsy might be carried out by a GP & most patients will be referred to dermatologists.
It is SLE, though, that can cause subtle and/or wide ranging symptoms and it is a rare condition. Therefore it may take some time to be diagnosed. It is an autoimmune disease so antibodies are associated with inflammation, and this inflammation can occur in a wide range of areas of the body.
The symptoms of SLE might include achey muscles and joints, a red rash on the cheeks and nose, a rash worse with the sun, mouth ulcers, hair falling out, and poor circulation to the fingers and toes with the cold (raynaud's). The vast majority of people with one of these symptoms will not have lupus. SLE can go on to affect many body systems such as the kidneys, nervous system & lung. Like most conditions, some people have it mildly and some have it severely, but modern treatments are usually very effective.
The american college of Rheumatology have updated their criteria for the diagnosis of lupus and typically require at least 4 of the following (This is taken from the american college of rheumatology website). Don't worry, though about the lungs, heart and nervous system as these are really in the severe cases. It's really the skin, joints, mouth ulcers and blood tests that make up the diagnosis.
As you can see, you only need 1 or 2 symptoms to make the diagnosis if the blood tests are all positive and/or the kidney has protein in it. So a blood & urine test will be needed. It's rare, though, and most people tested in the general practice setting don't have it.
The “Eleven Criteria”
1. Malar rash: butterfly-shaped rash across cheeks and nose
2. Discoid (skin) rash: raised red patches
3. Photosensitivity: skin rash as result of unusual reaction to sunlight
4. Mouth or nose ulcers: usually painless
5. Arthritis (nonerosive) in two or more joints, along with tenderness, swelling, or effusion. With nonerosive arthritis, the bones around joints don’t get destroyed.
6. Cardio-pulmonary involvement: inflammation of the lining around the heart (pericarditis) and/or lungs (pleuritis)
7. Neurologic disorder: seizures and/or psychosis
8. Renal (kidney) disorder: excessive protein in the urine, or cellular casts in the urine
9. Hematologic (blood) disorder: hemolytic anemia, low white blood cell count, or low platelet count
10. Immunologic disorder: antibodies to double stranded DNA, antibodies to Sm, or antibodies to cardiolipin
11. Antinuclear antibodies (ANA): a positive test in the absence of drugs known to induce it.
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