Decoding your Lupus labs: What do all those letters mean? Asena Bahce-Altuntas, MD Rheumatologist Jacobi Medical Center

Who gets Lupus? In the US, it is estimated as many as 1.5 million people have Lupus 1.8 to 7.6 people per 100,000 are diagnosed with Lupus each year Most cases are diagnosed between age 15 and 40 Primarily women are affected (6-10 F:1 M) African Americans (and possibly Latinos, Asians and Native Americans) are affected more than whites (1, 2)

Can one blood test alone mean that I have lupus? No. This is a common misconception. A blood test alone does not mean a diagnosis of Lupus Having Lupus is a combination of symptoms and blood tests

What is Lupus? Lupus is a chronic autoimmune disease Causes systemic inflammation which affects multiple organs Kidney and brain are the most serious The cause is not well known

What is an AUTOIMMUNE DISEASE? What is your IMMUNE SYSTEM? Group of cells that DEFEND the body against bacteria, microbes, viruses, toxins and parasites What is Autoimmune Disease? In patients with autoimmune disease, like Lupus, the immune system is confused and overactive, and starts to ATTACK ITS OWN BODY and ORGANS

What are lupus symptoms? Skin rash and photosensitivity Joint pain and swelling Tiredness Fever Shortness of breath Hair loss Sores in the mouth and/or nose

What is a butterfly or malar rash? It is a rash that appears on the cheeks, but spares the nasolabial folds It is a classic rash in Lupus It often occurs after being in the sunlight

What is a discoid rash? A discoid rash is also a classic rash in Lupus Rash is often red, raised and can cause scarring Rash often looks like small circles or discs Most common on the face, ears and scalp

What kind of arthritis happens with lupus? Joint tenderness, swelling and redness Usually worse in the morning Deformities of the joints can occur Typically, on x-ray the BONES are not damaged

Lupus Diagnosis American College of Rheumatology Criteria for Classification of Lupus (4 or more of 11= Lupus) 1--Butterfly rash (malar) 2--Discoid rash 3--Photosensitivity 4--Oral ulcers 5--Swollen/painful joints 6--Pleuritis or pericarditis (water around lungs/heart) 7--Kidney problems 8--Seizures or psychosis 9—Anemia, Leukopenia, Thrombocytopenia 10--Special positive labs: Anti-dsDNA, Anti-Sm or APL 11--Positive ANA lab (Anti-nuclear antibody)

What is the ANA test? ANA = Antinuclear antibody Antibodies = proteins that normally fight bacteria & viruses Anti = against Nuclear = Nucleus of a cell 95% of lupus patients have a positive ANA However, 5% of healthy people have a positive ANA and do not have Lupus Having a +ANA does NOT mean you have lupus (1,2)

Other lab tests in lupus Anti-Smith antibody (anti-SM) Anti-double stranded DNA (anti-dsDNA) Complement (C3/C4) Anti-Ro antibody (aka SSA) Anti-La antibody (aka SSB) Erythrocyte Sedimentation Rate (ESR) C-reactive protein (CRP) Blood clotting tests (Lupus anticoagulant, etc.)

Anti-Smith Very specific to Lupus Seen only in some racial populations Even if negative, you can still have Lupus We do not follow the level of Smith Ab

Anti-dsDNA More specific to Lupus We follow the levels of dsDNA If Anti-dsDNA levels are HIGH it means that your Lupus is MORE ACTIVE

What is complement? Complement is something in your blood that fights infection, or in the case of Lupus it can attack your own cells If complement (C3/C4) is LOW then your Lupus may be ACTIVE If your Lupus is in good control, this value will be normal or high

Anti-Ro and La (SSA or SSB) These are not positive in all patients However, if these are positive it can mean that you are more likely to have symptoms of dry eyes or dry mouth It also means that if you are pregnant, the baby is at higher risk of heart problems

What is ESR or CRP (Erythrocyte sedimentation rate or C-reactive protein)? Markers of general inflammation in your body in the blood Can be elevated for a number of reasons including infections (pneumonia, common cold, etc) or from Lupus Your doctor is looking to see if this lab value is HIGH If high, your Lupus may be active

Why blood clotting tests? Some, but not all, Lupus patients are more likely to get blood clots or have miscarriages Your doctor will send special tests to see if you have this problem: Lupus anticoagulant Anti-cardiolipin antibodies B2-glycoprotein antibodies

Why check my urine? Lupus can damage your kidneys and your urine tells us if your kidneys are ok In the urine, we look for protein and blood Healthy people have NO PROTEIN and NO BLOOD in the urine So we are looking for “PROTEINURIA”, i.e. protein in the urine

Why would lupus make me anemic? Anemia is when your RED BLOOD CELLS are low Anemia can make you very tired In Lupus, your body does not recognize that your cells are part of your body The lupus cells attack and kill your own red blood cells, and this makes you anemic

What about Leukopenia and thrombocytopenia? Leukopenia is when your WHITE BLOOD CELLS are low White blood cells prevent infection Leukopenia is very common in active Lupus, but rarely is low enough to lead to infection Leukopenia can be caused by some drugs used to treat Lupus Thrombocytopenia is when your PLATELETS are low Platelets are cells that prevent bleeding Bleeding is rare in Lupus, unless your platelets are very, very low

If I have lupus, what is my doctor looking for in my labs? In general, if you have lupus your doctor will check your labs every three to six months Your doctor wants to see in your labs if your lupus is active: Signs of inflammation (elevated ESR/CRP) Signs of active lupus (low red & white blood cells, platelets) Signs of active autoimmune disease (elevated dsDNA, and/or low complement--C3/C4) Signs of kidney problems (urine test)

Should my mother/sister/daughter get tested for lupus? If your family member does not have any signs or symptoms of Lupus, then testing can lead to needless anxiety Without symptoms you cannot have Lupus However, if your family member does have signs or symptoms of Lupus, then testing would be appropriate

Summing it Up A positive ANA does not mean that you have Lupus Lupus is a combination of labs and symptoms ACTIVE LUPUS = ESR/CRP--high ANA/dsDNA--high Complement--low +Anemia/leukopenia/thrombocytopenia Protein in urine Your doctor will check your blood and urine periodically How often depends on your symptoms, but in general every 3 months Following with your doctor is important, and so is understanding what your doctor is looking for in the labs so you can work together to feel your best

References 1-Pisetsky DS, Buyon JP, Manzi S. Chapter 17. Systemic lupus erythematosus. In: Klippel JH, Crofford LJ, Stone JH, Weyand CM. Primer on the Rheumatic Diseases. Edition 12. Arthritis Foundation, Atlanta, GA., 2001. Rus V, Hajeer A. 2-Hochberg MC. Chapter 7. Systemic lupus erythematosus. In: Silman AJ, Hochberg MC (eds.) Epidemiology of the Rheumatic Disease. 2nd edition. Oxford University Press, New York, 2001.

Thanks To Thanks to the Lupus Research Alliance for asking me to speak My colleagues at Jacobi Medical Center: Beverly Johnson, MD Barbara Mendez, MD Peter Barland, MD