Despite increased awareness and improved diagnostic methods, the time interval between initial symptom presentation and systemic lupus erythematosus (SLE) diagnosis remains long. As a chronic disease with no known cure, systemic lupus erythematosus, also referred to as lupus, requires appropriate treatment interventions to manage symptoms, prevent flare-ups, and decrease the risk of adverse health consequences. Well-established as difficult to diagnose, the condition often presents with symptoms that can be mistaken for other diseases. As a result, delays in diagnosis, care, and treatment can last up to several years, leaving many patients with unwanted symptoms but no official diagnosis.
Diagnostic Delays and Lupus Outcomes
According to a recent study, the time to diagnosis and lupus outcomes – such as quality of life, disease-related damage, and disease activity – are closely linked. Diagnostic delays can significantly decrease patient quality of life while increasing the risk of disease-related damage. Results of the study report that patients with neuropsychiatric systemic lupus erythematosus (NPSLE) experience the longest time to diagnosis, highlighting the importance of a comprehensive evaluation of psychiatric symptoms. Further, the research findings verified the correlation between early diagnosis and improved health outcomes, emphasizing the need for enhanced training, education, and awareness campaigns.
Classification of Lupus
In clinical care, conditions with comparable symptoms such as rheumatoid arthritis, systemic sclerosis, vasculitis, dermatomyositis, and drug- or virus-induced arthritis should be ruled out prior to a lupus diagnosis.
Currently, no single test is used to diagnose lupus; however, the American College of Rheumatology (ACR) has devised classification criteria to assist clinicians in diagnosis. Although a classification of lupus is not synonymous with a diagnosis, the presence of four or more criteria indicates a reasonable certainty exists for the diagnosis of lupus. As specified by the ACR, criteria include malar rash; discoid rash; photosensitivity; oral or nasal ulcers; arthritis of multiple joints; serositis; kidney disease; neurological disorders; and blood disorders. Common symptoms which are not included in the criteria but are often associated with lupus include hair loss or breakage and Raynaud’s Phenomenon.
Testing for Lupus
In examining a patient for suspected lupus, clinicians can utilize medical history data, family history of lupus, physical exams, blood and urine tests, as well as skin or kidney biopsies to assist with diagnosis.
A complete blood test is one of the primary testing components, and its results may indicate the presence of anemia and low white blood cell or platelet levels, which occur in lupus patients. Erythrocyte sedimentation rate testing may be useful with faster than normal results indicating systemic disease.
In addition, standard blood testing includes the antinuclear antibody (ANA) test, which reveals whether the immune system has produced lupus autoantibodies. The majority of patients with lupus test positive for ANA; however, a positive ANA result does not always indicate lupus. Positive ANA results should be verified with further testing, including specific SLE antibody testing.
Furthermore, skin and kidney biopsies can be conducted to detect signs of autoimmune disease and associated organ damage. Depending on clinical presentation, other types of testing may be required to ascertain a diagnosis.
Reducing Time to Diagnosis
As evidence suggests, shortening the average time to diagnosis in patients with SLE has considerable advantages on their outcomes. Comprehensive testing, symptom monitoring, and improved patient education are necessary steps toward early diagnosis. In addition, improved access to rheumatologists and accelerated access to specialized rheumatology centers can contribute to an early diagnosis and better outcomes.
Patients with systemic lupus erythematosus often present with symptoms that can be mistaken for other diseases and, therefore, experience delays in diagnosis and treatment. Comprehensive testing, improved provider and patient education, and thorough clinical investigation are vital tools that can facilitate early diagnosis and thus, improve patient outcomes.