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

2. Who gets Lupus?
In the US, it is estimated as many as 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)

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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)

11. 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)

12. 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.)

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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)

23. 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

24. 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

25. 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., 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.

26. 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