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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.
We saw the rheumy today. She took a medical history, which besides a sudden joint pain starting 5 weeks ago (and one great uncle with RF) there was nothing else to report. She reviewed all the lab results and as you both (Vee and Ladybud) predicted, she said she needs to do more tests (waiting 2 weeks). She said some of the present test results plus the multiple joint pain (with some finger swelling added in the past two weeks) point to the direction of lupus but she is not sure yet and needs more information . She said although anti-ANA of 1:320 is meaningful but itís not too strong, and added that anti-ds-dna that was done with IFA is not very sensitive (could give false positive) and she would repeat it this time with FARR. The next set of tests will include some repeats (sed rate, CRP, RF, anti-CCP, anti-ds-dna, ENA/Smith RNP, and complete urinalysis) and some new ones (anti-thyroglobulin, cardiolipin IgG) and also added g6pd to the tests for when she would have to go on Plaquenil.

She prescribed Medrol for symptom relief, starting with 12 mgx5days, then 8 mgx5days, and then 4 mgx5days. Then based on the test result (if confirming lupus), she wants her to start with both Plaquenil and Methotrexate in about 3 weeks. Iím not so sure about starting both of these at the same time. She said Plaquenil is a weak drug and very slow acting and with the amount of inflammation going on, she would need Methotrexate and will have to stay on it indefinitely?!! She was very kind and a chatty one but I really like us to see a top notch rheumy in a teaching/research institution as soon as we can get an appointment, which I hear can take months! I will really appreciate it if you can comment on what this rheumy proposed.

p.s. I got a copy of the urine test that was done last month and it says complete urinalysis, so it was not by dipstick. But when I asked the nurse if the urinalysis included testing for cell casts, she said it didn't because thatís a separate test/order. Today when I asked the rheumy about it, she said the cell cast is part of the UA and always when RBC or WBC is seen in urine, they make sure to check for cell cast too, and there was none in her urine!!





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