Lupus: 5 Questions on Diagnosis

In January 2018, the British Society for Rheumatology published new guidelines for the diagnosis, monitoring, and treatment of non-renal manifestations of systemic lupus erythematosus (SLE) in adults.¹ Here, we offer a 5-question quiz based on these guidelines that focuses on the diagnosis of lupus.

Question 1

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ANSWER: C. 5%

A positive ANA test occurs in 5% of the adult population, and ANAs are present in 95% of patients with SLE.

Question 2

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ANSWER: B. Women during the reproductive years

Although SLE can occur at any age, it most frequently presents in women during the reproductive years.

Question 3

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ANSWER: A. True.

Survival may be improving, but life expectancy is still poor compared with the general population.

Question 4

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ANSWER: D. Anti-Ro/La antibodies

The presence of anti-dsDNA antibodies, low complement levels, or anti-Smith (Sm) antibodies is highly predictive of SLE in patients with relevant clinical features. Anti-Ro/La and anti-RNP antibodies are less specific markers because they are found in other autoimmune rheumatic disorders as well as SLE.

Question 5

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ANSWER: A. True

All patients with lupus should be tested for antiphospholipids because their presence indicates an elevated risk of arterial/venous thrombotic events and adverse pregnancy outcomes. Confirmatory tests for antiphospholipid syndrome are positive lupus anticoagulant, anticardiolipin (IgG, IgM), and/or anti-beta-2 glycoprotein-1 (IgG, IgM) on 2 occasions at least 12 weeks apart.

For an overview of the highlights of the guidelines, please see Lupus Management Guidelines From the British Society for Rheumatology.

References:

1. Gordon C, Amissah-Arthur MB, Gayed M, et al, for the British Society for Rheumatology Standards, Audit and Guidelines Working Group. The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. Rheumatology. 2018;57:e1-e45. doi: 10.1093/rheumatology/kex286.