Antinuclear Antibody (ANA)
Red patches of skin associated with keratotic scaling and follicular plugging, some atrophy in older lesions
Skin rash after exposure to sunlight
Oral or nasopharyngeal ulcers
Serosal surface inflammation – pleura, pericardium, peritoneum
Non-erosive flitting arthralgias, also tenosynovitis of flexor tendons
Persistent Protein/haematuria and nephrotic syndrome, renal biopsy to confirm classification of focal, diffuse or membranous glomerulonephritis
Seizures or neurocognitive dysfunction or psychosis
Haemolytic anaemia, leucopenia, lymphopenia or thrombocytopenia
Anti-ds DNA, Sm, antiphospholipid antibodies (abnormal IgM or IgG, lupus anticoagulant) or false positive syphilis serology
Anti-Ro (anti-SS-A) and Anti-La (anti-SS-B)
A & C 30%
Sensitivity poor, seen in overlap syndromes
Ro – up to 50%
La – 10-15%
Raynaud’s, mild renal disease
Drug induced lupus
Urine analysis is very important as proteinuria can indicate kidney involvement, especially in a patient with raised urea and creatinine levels. The estimated glomerular filtration rate (e-GFR) and a renal biopsy may be required to confirm this. Complement deficiency (C3 and C4 proteins) is also present in lupus during times of disease flare. Cholesterol levels should be checked regularly as lupus can lead to accelerated atherosclerosis. Thyroid function can also be affected.
Blood monitoring is essential to the complete diagnosis of lupus, although due to the multi-system nature of the disease, monitoring of other aspects of disease activity and systemic review in clinic is essential to prevent major flares of lupus.
One of the most important roles of the nurse specialist is to support and advise patients especially in times of flare of the disease. Patients can learn to recognise ‘red flags’ when medical help is required urgently and can also learn ways of managing their unpredictable symptoms in different ways. By mastering self-management techniques, patients can manage difficult times and plan realistic achievable goals to remain in control of their lupus wherever possible.