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What is Lupus?
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Symptoms

Although lupus can affect any part of the body, most people experience symptoms in only a few organs. This table lists the most common symptoms of people with lupus.

Symptom Percentage
Achy joints (arthralgia) 95%
Fever more than 100 degrees F (38 degrees C) 90%
Arthritis (swollen joints) 90%
Prolonged or extreme fatigue 81%
Skin Rashes 74%
Anemia 71%
Kidney involvement 50%
Pain in the chest on deep breathing (pleurisy) 45%
Butterfly-shaped rash across the cheeks and nose 42%
Sun or light sensitivity (photosensitivity) 30%
Hair loss 27%
Abnormal blood clotting problems 20%
Kidney involvement 50%
Raynaud's phenomenon (fingers turning white and/or blue in the cold) 17%
Seizures 15%
Mouth or nose ulcers 12%


Diagnosis

Because many lupus symptoms mimic other illnesses, 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 College of Rheumatology (ACR) in 1982 issued a list of 11 symptoms or signs that help distinguish lupus from other diseases (see table below). This has recently been revised. 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.

Criterion Definition
Malar Rash Rash over the cheeks
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 Nonerosive arthritis involving two or more peripheral joints (arthritis in which the bones around the joints do not become destroyed)
Serositis Pleuritis or pericarditis (inflammation of the lining of the the heart
Renal Disorder Excessive protein in the urine (greater tahn 0.5 gm/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 Disorder Seizures (convulsions) and/or psychosis in the absence of drugs or metabolic disturbances which are known to cause such effects
Hermatologic Disorder Hemolytic anemia or leukopenia (white blood count below 4,000 cells per cubic millimeter) ore 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
Antinuclear Antibody Positive test for antinuclear antibodies (ANA) in the absence of drugs known to induce it
Immunologic Disorder Positive anti-double stranded DNA test, positive anti-Sm test, positive antiphospholipid andtibody such as anticardiolipin, or false positive syphilis test (VDRL)

All information is from:
Robert G. Lahita, M.D., PH.D.
Chief, Division of Rheumatology and Connective Tissue Diseases
St. Luke's/Roosevelt Hospital Center

Associate Professor, College of Physicians and Surgeons
Columbia University, New York, NY

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