Diagnosis
There is no single test to diagnose SLE. It is a complex disorder and it can be difficult to diagnose. To assist with a diagnosis the doctor will take a full medical history, including any family history of SLE. They will discuss nature and severity of current symptoms experienced and will conduct a thorough physical assessment. A urine sample will also be analysed to check for kidney involvement.In order to confirm a diagnosis, blood tests will be taken. Blood tests performed may include:
Complete blood count
This will show the number of red and white blood cells in a specimen of blood. This will determine if a patient is suffering from anaemia or leucopaeniaBiochemistry
This will show the balance of electrolytes in the body and can indicate abnormalities with the function of the kidneys and other internal organs.Erythrocyte sedimentation rate (ESR)
An elevated ESR indicates the presence of inflammation in the body.Antinuclear antibody test (ANA)
The ANA test detects the presence of autoantibodies. This test is positive in 95% of SLE cases, however there are a number of other causes for a positive ANA result, including other autoimmune diseases and infection. If the test is negative, SLE is unlikely.Other autoantibody tests
Sometimes tests for other autoantibodies that are specific to SLE are performed to confirm a diagnosis. These may include tests for complement enzymes, antiphosphiloid antibodies, lupus anticoagulant and antibodies to DNA (anti-dsDNA).Coagulation studies
These measure the clotting ability of the blood. Abnormalities can be associated with an increased risk of blood clots in some people with SLE. If SLE is suspected or confirmed a referral to a specialist (usually a rheumatologist) may be recommended.Treatment
Whilst SLE cannot be cured, it can be controlled. Treatment involves monitoring the condition, preventing flares and treating the symptoms when they occur. The type of treatment given will depend on the severity of the condition and the degree to which the different body systems are affected. Often treatment is a team approach with several different health professionals involved and a combination of treatments used. With appropriate treatment 80%-90% of people with SLE can look forward to a normal life span.Treatment options include:
Medications
Anti-inflammatory medications (such as aspirin) or non-steroidal anti-inflammatory drugs (NSAID's) can help to reduce pain and inflammation. To avoid irritating the stomach, it is usually recommended that these medications be taken with food.Other medications that may be used include:
- Corticosteroid (steroid) medications - These are commonly used in the treatment of moderate to severe cases of SLE and work by suppressing inflammation. They can be given as tablets, as a cream applied to the skin, or by injection. Examples of these medications used to treat SLE are prednisone, hydrocortisone and dexamethasone.
- Anti-malarial medications - It is not entirely clear how these medications work to treat SLE, however it is thought that they reduce the autoimmune response. An anti-malarial medication commonly used in the treatment of SLE is Hydroxychloroquine.
- Immunosupressive medications - These help to dampen down the abnormal response of the immune system and can be given as tablets or as an infusion into a vein. Examples of these medications used to treat SLE include azothiaprine, methotrexate and cyclophosphamide.
- Gamma globulins - In severe cases of SLE these medications may be given to strengthen the immune system.
Rest and Exercise
Rest will help reduce fatigue, pain and inflammation. Exercise is also important to maintain muscle strength, decrease joint deformities and stiffness, and to maintain mobility. A physiotherapist can recommend an appropriate exercise regime. When SLE is more active, more rest is required.Avoiding sunlight
Because sunlight can trigger flares and skin rashes in some people with SLE, it is important that SLE sufferers who are sensitive to the sun should avoid sun exposure, particularly between 11.00am and 3.00pm. Protective clothing and sunscreens with a sun protection factor of 15+ should be worn when in the sun.Alternative therapies
Reducing stress is vital for people with SLE and many people find that techniques such as meditation, yoga and hypnotherapy can assist with stress reduction. Acupuncture and massage is effective for some people in reducing joint and muscle pain. Dietary factors are also important and a diet low in red meat and dairy products is thought to help reduce pain and inflammation. Also, some foods, such as alfalfa sprouts, and dietary supplements, such as Echinacea, have been implicated in causing SLE flares and should be avoided. Homeopathy and vitamin supplements may also assist with overall improved health. It is important to discuss any alternative therapies with the doctor or specialist before undertaking them to insure that they will not interfere with medical treatments. For advice on dietary factors, consult a dietitian.(published with permission in writing from:http://www.southerncross.co.nz)
