Diagnosis can be difficult and may take years. Lupus can affect all the body’s organs. Its symptoms overlap with many other diseases and the intensity of those symptoms may fluctuate. Because of this, it may take years to get a conclusive diagnosis of lupus. In the early 1980s, the American College of Rheumatology devised classification criteria to help identify the disease. Four of the symptoms must be present for a positive diagnosis, but the symptoms need not occur simultaneously. On rare occasions, a person with many signs and symptoms of lupus does not meet the criteria. These people are said to have “latent lupus” or “undifferentiated connective tissue disease.”

The signs and symptoms include:

Malar rash: Red, flat or raised, over the cheeks and the bridge of the nose

Discoid rash: Red, disc-shaped, raised, scaly patches that tend to scar

Photosensitivity: Reaction to sun or ultraviolet light that results in a rash

Oral ulcers: Ulcers in the nose or mouth, or on the tongue, that are usually painless

Arthritis: Pain, stiffness and swelling in two or more lower arm or leg joints

Serositis: Inflammation of the lining around the heart, lungs or abdomen; pain associated with movement such as breathing, often associated with shortness of breath

Kidney involvement: Excessive protein in the urine and possible swelling in the lower legs; presence of red or white blood cell aggregates in the urine

Neuropsychiatric disorders: Seizures or psychosis are the major signs, though numerous other disorders are associated with lupus

Blood tests may uncover one or more of the following:

Blood disorders: May include anemia, which is low red blood cell count, low white blood cell count or low platelet count

Antinuclear antibodies: The presence of abnormal quantities of autoantibodies. A positive antinuclear antibody, or ANA, test is not conclusive proof of the disease. But 98 percent of people with lupus have a positive result. Your physician may test for other autoantibodies, as well. In order to solidify the diagnosis, the doctor may test for a large number of autoantibodies.

Other tests may help determine whether there has been inflammation in or damage to the kidneys and liver. Your doctor will order a urinalysis and may order a kidney biopsy. (A biopsy is an analysis of a tissue sample.) You may also be asked to have a chest X-ray, electrocardiogram or echocardiogram to determine if there is inflammation in or damage to the heart or lungs.

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