Lupus Diagnosis: Eleven Criteria for a Positive Diagnosis

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A positive ANA is only an indicator which points in several possible

directions,

and indicates that further investigation and analysis may be needed. It

is not a question of how high the ANA titer is. Even a very high titer

ANA by itself is never sufficient to diagnose lupus. Other criteria

must

be satisfied.

In systemic lupus, eleven criteria were developed for research

purposes

but are frequently used to diagnose lupus.

Malar Rash: Rash over the cheeks

Discoid Rash: Red raised patches

Photosensitivity: Reaction to sunlight, resulting in the

development of

or increase in skin rash

Oral Ulcers: Ulcers in the nose or mouth, usually painless

Arthritis: Non-erosive arthritis involving two or more peripheral

joints

(arthritis in which the bones around the joints do not become destroyed)

Serositis: Pleuritis or pericarditis (inflammation of the lining

of the

lung or heart)

Renal Disorder: Excessive protein in the urine (greater than 0.5

gm/day

or 3+ on test sticks) and/or cellular casts (abnormal elements the

urine,

derived from red and/or white cells and/or kidney tubule cells)

Neurologic Disorder: Seizures (convulsions) and/or psychosis in

the absence

of drugs or metabolic disturbances which are known to cause such effects

Hematologic Disorder: Hemolytic anemia or leukopenia (white blood

count

below 4,000 cells per cubic millimeter) or lymphopenia (less than 1,500

lymphocytes per cubic millimeter) or thrombocytopenia (less than

100,000

platelets per cubic millimeter). The leukopenia and lymphopenia must be

detected on two or more occasions. The thrombocytopenia must be

detected

in the absence of drugs known to induce it.

Antinuclear Antibody: Positive test for antinuclear antibodies

(ANA) in

the absence of drugs known to induce it.

Immunologic Disorder: Positive anti-double stranded anti-DNA

test, positive

anti-Sm test, positive antiphospholipid antibody such as

anticardiolipin,

or false positive syphilis test (VDRL).