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Diagnosis of Systemic Lupus Erythematosus

The doctor will ask about your symptoms and medical history, and perform a physical exam. Systemic Lupus Erythematosus (SLE) is first suspected on the basis of symptoms, especially if you are a young woman. A firm diagnosis of SLE is somewhat complicated and will require a great deal of information and the consultation of a specialist. This is because SLE has no identifiable cause and no single definitive test. Also, since SLE can affect many systems in the body, it does not show the same signs and symptoms in everyone.

The American College of Rheumatology has a set of criteria to help make an accurate diagnosis. This diagnosis requires that you have at least four of the following:

  • Typical (malar) facial rash
  • Typical (discoid) rash on sun-exposed areas
  • Skin photosensitivity (easily burned by the sun)
  • Ulcers in the mouth or above the back of it (the nasopharynx)
  • Arthritis in at least two limb joints—meaning that a joint is painful, swollen, warm, and red, not just painful
  • Inflammation of the lining of the heart or lungs (serositis)
  • Kidney abnormalities—identified by kidney function tests (For example, protein in the urine is a sign that the kidneys are affected.)
  • Seizures or psychosis
  • Abnormally low number of blood cells—determined by a blood test called a complete blood count (CBC)
  • Antinuclear antibodies—This is determined by a specific lab test. Nearly all people with SLE test positive for these antibodies. They are immune chemicals produced by your body that attack the contents of the nuclei of your body's cells. These antibodies are believed to contribute to the cause of SLE.
  • Immune dysfunction—In people with SLE, several other antibodies have been found. These antibodies can be detected with specific lab tests.

Revision Information

  • Guidelines for referral and management of systemic lupus erythematosus in adults. American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Guidelines. Arthritis Rheum. 1999;42(9):1785-1796.

  • Handout on health: Systemic lupus erythematosus. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Lupus/default.asp. Updated August 2011. Accessed June 28, 2013.

  • Systemic lupus erythematosus (SLE). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated June 13, 2013. Accessed June 28, 2013.

  • Understanding lupus. Lupus Foundation of America website. Available at: http://www.lupus.org/webmodules/webarticlesnet/templates/new%5Flearnunderstanding.aspx?articleid=2231&zoneid=523. Accessed June 28, 2013.

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