|Articles|October 4, 2012

Lupus: The Role of the Primary Care Physician. Part 1: Diagnosis

Diagnosing systemic lupus erythematosus (SLE) can take 2-3 years, because most symptoms are both common and nonspecific. Here are clues to quick, accurate detection.

Aiming to improve outcomes for lupus patients, the Lupus Initiative of the American College of Rheumatology has launched a series of educational tools for lupus diagnosis and treatment in primary care. The focus is on coordination of care, as well as cultural competence and empowering patients.

This is the first article in a three-part series that provides an overview of the role of the primary care physician in diagnosis, treatment, and patient self-management.Part 1: The Role of the Primary Care Physician in Diagnosis

Systemic lupus erythematosus (SLE) can be especially difficult to diagnose, taking two to three years from the onset of symptoms to final diagnosis. The challenge in diagnosing this disease can be largely attributed to the varied list of non-specific, fairly common symptoms. In addition to the well-known symptoms such as joint pain and swelling, skin rashes, and the tell-tale butterfly

shaped rash across the nose and cheeks, patients may also present with lesser- known symptoms such as:

•    Cognitive dysfunction including difficulty focusing, memory loss, and depression
•    Headaches
•    Anemia
•    Pleurisy and/or pericarditis
•    Abnormal blood clotting
•    Seizures
•    Ulcers of the mouth and/or nose

Many of these symptoms mimic other diseases including viral syndromes, depression, fibromyalgia, and allergies, all of which are common in a primary care setting, contributing to the difficulty in diagnosis.

The takeaway: When a number of these symptoms are present and do not resolve, lupus should be considered.

Keep in mind that SLE is not a rare disease, especially among women of child-bearing age and minorities. It is most common in women of non-European descent: Blacks, Hispanics, Asians, and Native Americans. It also occurs to a lesser extent in younger and older populations and in men.

Once lupus is suspected, primary care physicians should refer patients to a rheumatologist for final diagnosis and treatment.

For more information on optimal diagnosis and treatment of lupus, visit The Lupus Initiative at http://thelupusinitiative.org.