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Complement, SLE is dx'ed using 11 "classification criteria" pre-established by the American College of Rheumatology (ACR). You may find them in the "sticky posts" (permanent info posts)*, located above the user threads. Generally (but not always) you must meet 4 or more of the 11 for a dx of systemic lupus. They need not present simultaneously, btw; instead, envision checking each off in *indelible ink* once it's fulfilled.

*The "stickies" are pretty abbreviated. You could find fuller explanations of the criteria in hardcovers, etc. Complicating matters, a newer set of ACR criteria is being test-driven by some rheums, but this newer (and wordier) version doesn't seem to have been accepted by the ACR & maybe never will be.

Below, I kept my focus on only several criteria, the ones you've alluded to. In my (patient's) mind, some 64k questions might be---

(a) IS ANA high enough to be counted? (With the older tests, weak positives aren't counted, like 1:40 or 1:80. I've seen articles and books in which doctors cite various levels---1:320, 1:640, or 1:1280---as countable. Problem is, the new "multiplex" tests described by Alicake use a different scale. But the concept is the same, I bet: what is a "weak positive" vs. "positive" vs. "strong positive"? Also note that things other than an AI disease can cause a positive ANA, presumably in the lower range of numbers, e.g., viral or bacterial infection, family tendency, age, etc.

(b) Is anti-ds-DNA high enough to be counted? Same concept as above, meaning what level counts...? Also, you'll note that only several AB's "make" the ACR list: anti-ds-DNA, anti-Sm, antiphospholipid, lupus anti-coagulant, and false-positive syphilis test. Certain "fuzzier" antibodies are possible and likely add some weight although not creating a checkmark, e.g., anti-ribosomal P, antineuronal, anti-RNP, anti-Ro, anti-La, etc. (You could find a full listing of AB's elsewhere.)

(c) Is "kidney disorder" present? Note this is defined as PROTEIN or ABNORMAL SEDIMENT. (RBC isn't the same as protein & isn't a criterion).

(d) Will arthritis be counted? (Other causes must be ruled out, like Lyme as one example... I think.)

Some criteria have thresholds and/or special embedded meanings. For example, under "blood abnormalities", [B]hemolytic anemia [/B] is the form of anemia created by premature destruction of RBCís (from the disease or from an antibody targeting RBCís); and it has thresholds (but I don't know them).

Also, many symptoms that don't make the list are extremely common in lupus but arenít "specific" enough to be listed because there are so many other causes for them ([B]elevated ESR[/B] is a good example).

[B]RBC in urine[/B]. RBC isn't a criteria. RBC may be caused by many things, like kidney or bladder infection, stones, kidney injury, certain meds, exercise, other kidney conditions, etc. Re: the part of your question about dipstick vs. urinalysis, I think a dipstick test can detect [B]protein [/B](which IS a criteria) but not [B]casts [/B](which are also a criteria)Ö and that she needs urinalysis (urinalysis is both more complete and more reliable).

Bottom line on the kidney criteria: a person can have lupus without having "kidney involvement"... or any "major organ involvement" for that matter (major organs being defined as kidney, brain, heart, lungs, etc.) But having lupus doesn't rule out getting other kidney problems like stones, infections & the like. (I have lupus without kidney involvement; and I have kidney stones as a separate issue.)

[B]Complement levels[/B]. Per my hardcover, these are 28 plasma proteins whose interactions kill bacteria and clear away immune complexes. During inflammation, they decrease, and low levels can suggest that lupus is active. As for prognostic value, I think it's like many (probably most) of these criteria: they can rise and fall as flares come and go. Blood labs & urinalysis are only snapshots in time trying to trap lupus, a roller coaster...

Just give a yell if above isn't what you were after or doesn't make enough sense. I hope others correct and/or add more.

As I said, I can't even guess if a doctor will call this lupus, or "lupus in the making", or "we need to recheck her down the road", or... I only wanted to convey some of the nuances buried in the criteria. In that any somewhat elevated ANA and anti-ds-DNA put lupus on the radar, in her shoes I'd definitely want fully evaluated and to get myself well-established with a rheum. Some rheums (the chatty ones who seek to educate) explain which criteria you've met & why, also which you haven't & why. Others are Delphic oracles, uttering pronouncements with no explanations (I found that type horrible). So if you encounter the Delphic type, just ask really good questions! (Here we're pretty good at helping people formulate those.)

I think you're making great inroads on the critical concepts. When is her appointment? Looking forward to updates. Sending hugs to you both, Vee

P.S. I also misspelled "Alicake", sorry. :o
P.P.S. I once read an article by a world-famous British rheum in which he said (I paraphrase) that any 'ole doctor can diagnose lupus in the presence of really high ANA and anti-ds-DNA, palpable malar rash, and lupus nephritis proven by biopsy. Well, no wonder: those are "classic" criteria & suggest a serious degree of lupus. It's all those MILDER cases that present the real diagnostic challenge, he added.





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