Table 17.2.

(continued)

Discoid rash

Red raised patches

Photosensitivity

Reaction to sunlight, resulting in the development of or increase in skin rash

Oral ulcers

Ulcers in the nose or mouth, usually painless

Arthritis

Non-erosive arthritis involving two or more peripheral joints (arthritis in which the bones around the joints do not become destroyed)

Serositis

Pleuritis or pericarditis

Renal disorder

Excessive protein in the urine (greater than 0.5 g/day or 3+ on test sticks) and/or cellular casts (abnormal elements in the urine, derived from red and/or white cells and/or kidney tubule cells)

Neurologic

Seizures

(convulsions) and/or psychosis in the absence of drugs or metabolic disturbances which are known to cause such effects

Hematologic

Hemolytic anemia or leukopenia (white blood count below 4,000 cells per cubic millimeter) or lymphopenia (less than 1,500 lymphocytes per cubic millimeter) or thrombocytopenia (less than 100,000 platelets per cubic millimeter). The leukopenia and lymphopenia must be detected on two or more occasions. The thrombocytopenia must be detected in the absence of drugs known to induce it

Immunologic

Positive LE prep test, positive anti-DNA test, positive anti-Sm test, or false-positive syphilis test (VDRL)

Positive test for anti-nuclear antibodies in the absence of drugs known to induce it

Because many lupus symptoms mimic other illnesses, complaints are sometimes vague and may come and go, lupus can be difficult to diagnose. Diagnosis is usually made by a careful review of a person’s entire medical history coupled with an analysis of the results obtained in routine laboratory tests and some specialized tests related to immune status. Currently, there is no single laboratory test that can determine whether a person has lupus or not. To assist the physician in the diagnosis of lupus, the American Rheumatism Association issued a list of 11 symptoms or signs that help distinguish lupus from other diseases. A person should have four or more of these symptoms to suspect lupus. The symptoms do not all have to occur at the same time.

Diagnostic criteria of progressive systemic sclerosis (scleroderma)

The American College of Rheumatology (ACR) criteria for the classification of scleroderma require one major criterion or two minor criteria, which are as follows:

Major criterion

Proximal scleroderma is characterized by symmetric thickening, tightening, and induration of the skin of the fingers and the skin that is proximal to the metacarpophalangeal or metatarsophalangeal joints. These changes may affect the entire extremity, face, neck, and trunk (thorax and abdomen).

Minor criteria

Sclerodactyly includes the above major criterion characteristics but is limited to only the fingers.

Digital pitting scars or a loss of substance from the finger pad: As a result of ischemia, depressed areas of the fingertips, or a loss of digital pad tissue occurs.

Bibasilar pulmonary fibrosis includes a bilateral reticular pattern of linear or lineonodular densities most pronounced in basilar portions of the lungs on standard chest roentgenograms. These densities may assume the appearance of diffuse mottling or a honeycomb lung and are not attributable to primary lung disease.