Indications directory

Clinical presentation:

The diagnosis lupus can be given with a 98 % specificity and a 97 % sensitivity, if there are 4 or more of the following ACR-criteria either concurrently or within any period of time during the course of illness.

ACR-criteria (1982)/classification criteria

1. Exanthema of the cheek
2. Discoid exanthema
3. Photosensitivity
4. Oral or nasopharyngeal ulcers
5. Non-erosive arthritis of the peripheral joints
6. Serositis (Pleuritis or pericarditis)
7. Nephropathy (Cell cylinders or proteinuria > 0,5 g/d)
8. Neurological disorders in the form of cramps or psychosis
9. Hematological disorders. Immune hemolytic anemia (Reticulocytosis, Coombs-test positive or leucopenia < 4000/µl or lymphopenia < 1500/µl or thrombocytopenia < 100,000/µl.
10. Immunological disorders (ANA positive or DsDNA-antibodies or Sm-antibodies detectable), several more autoantibodies
11. ANA positive (without evidence of medication with known ANA-inducing effect)

Basic evaluations:

ESR, CRP, blood count, urine status, creatinine-clearance, cystatin C

Immunology:

ANA (90-100 %), RF, anti-CCP, anti-ds-DNA (activity parameters), ENA (Sm 10-40 %, SS-A 25-60 %, SS-B 10-35 %, U1-RNP 30-40 %, further antibodies), cardiolipin antibodies (30-50 %) (Phospholipid antibodies), C3, C4, immune complexes.

SLE special types:

• Subacute cutaneous lupus erythematosus (SCLE): ANA, SS-A antibodies (60-100 %), SS-B antibodies (25-80 %).
• Chronic discoid lupus erythematosus (CDLE): ANA usually negative
• Neonatal lupus erythematosus (NLE): ANA mostly positive, SS-A antibodies (approximately 90 %), SS-B antibodies (approximately 70 %)
• Medication induced lupus erythematosus (mostly due to procainamide, hydralazine): ANA, ENA, histones, anti-ss-DNA (approximately 80 %)
• Congenital heart block in case of maternal SLE