Medical history and physical examination for lupus

A physical examination for suspected lupus (systemic lupus erythematosus, or SLE) includes a thorough check of your skin, joints, lungs and breathing, nervous system, and heart.

The medical history includes questions about:

• Arthritis, joint, or muscle pain.
• Weight loss or fatigue.
• Skin rashes, especially after exposure to sunlight.
• Sores in the mouth, nose, or other mucous membranes.
• Chest pain.
• Hair loss or thinning.
• Seizures, convulsions, or other nervous system symptoms.
• Whether anyone in your family has lupus.
• Whether you have ever had kidney disease.

A physical examination and medical history are done to evaluate symptoms. The parts of the body that are examined, and the questions that are asked, depend on which diseases your doctor suspects or considers most likely.

Your doctor will use certain criteria to distinguish lupus from other autoimmune and rheumatic diseases. You may have all of the lupus-related conditions at once or you may experience them over a period of time.

Classification criteria for systemic lupus erythematosus:¹

• Butterfly (malar) rash on cheeks
• Rash on face, arms, neck, torso (discoid rash)
• Skin rashes that result from exposure to sunlight or ultraviolet light (photosensitivity)
• Mouth or nasal sores (ulcers), usually painless
• Joint swelling, stiffness, pain involving 2 or more joints (arthritis)
• Inflammation of the membranes surrounding the lungs (pleuritis) or heart (pericarditis)
• Abnormalities in urine (test results show increased protein in the urine or clumps of red blood cells or kidney cells, called cell casts, in the urine)
• Nervous system problems, such as seizures or psychosis, without known cause
• Problems with the blood, such as reduced numbers of red blood cells (anemia), platelets, or white blood cells
• Positive antinuclear antibody (ANA) test
• Laboratory tests indicating increased autoimmunity (antibodies against normal tissue)

If you have at least 4 of these 11 conditions, you likely will be classified as having lupus.

Lupus is hard to diagnose because its symptoms are similar to those of many other disorders. A few nonspecific symptoms may persist for years before other problems develop.

When classic lupus symptoms develop quickly, lupus can be more easily diagnosed. If the symptoms are nonspecific or occur off and on, or if test results are inconclusive, it may take months or even years to make a definite diagnosis.

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Citations

1. Petri MA (2005). Systemic lupus erythematosus: Clinical aspects. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp.1473–1496. Philadelphia: Lippincott Williams and Wilkins.

Author:	Shannon Erstad, MBA/MPH	Last Updated May 17, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Stanford M. Shoor, MD - Rheumatology
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