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How to Test for Lupus

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  • When testing for lupus, antibody tests will help find abnormalities in antibody protein production
  • You need to take various tests in order to rule out other diseases, and see what abnormal antibodies and proteins remain in your system that can indicate lupus

Lupus is often called "the great imitator"1 since it can be confused with other ailments. To circumvent this, you have to undergo several tests, as it can be dangerous to be given the wrong diagnosis.

When testing for lupus, antibody tests will help find abnormalities in antibody protein production. Along with these tests, explaining any lupus-specific symptoms to your doctor (such as butterfly rashes) can make the final diagnosis more accurate. A study published in 2015 by Deutsches Ärzteblatt International outlines what laboratory tests are taken after a visual inspection.2

Diagnostic Tests for Lupus

Screening laboratory tests

Erythrocyte sedimentation rate

Blood count, differential blood count


Urinary status and sediment

Antinuclear antibodies (ANA) (HEp-2 cell test with fluorescence pattern)

Further laboratory tests after positive screening (particularly in case of positive ANA)

Further differentiation of ANA (particularly anti-Sm, -Ro/SSA, -La/SSB, -U1RNP antibodies, etc.)

Anti-dsDNA antibodies (ELISA; confirmation by radioimmunoassay or immunofluorescence test with Crithidia luciliae)

Complement C3, C4

Antiphospholipid antibodies, lupus anticoagulant

Glomerular filtration rate; 24-hour urine (if urine-protein positive), alternatively: protein/creatinine ratio in single urine sample; investigation for dysmorphic erythrocytes in sediment

Liver enzymes; lactate dehydrogenase; creatine kinase in presence of muscular symptoms

Further laboratory tests depending on clinical symptoms

Screening for comorbidities

Assessment of vaccination status

Follow-up (SLE: Every three to six months depending on disease course; lupus nephritis: initially every two to four weeks for the first two to four months)

Medical history, physical examination

Evaluate disease activity with standardized score

Evaluate damage according to standardized score (annually)

Repeat screening for comorbidities (at least once a year)

Ocular examination in patients taking hydroxychloroquine or chloroquine: baseline, then every six months (currently being revised by the German Society of Rheumatology in light of recommendations from the U.S.A)

Laboratory tests

Erythrocyte sedimentation rate

C-reactive protein (in suspected infection or pleurisy)

Blood count, differential blood count


Liver enzymes

Urinary status (protein/creatinine ratio, 24-hour urine and microscopic examination of urinary sediment as needed)

Complement C3, C4

Anti-dsDNA antibodies

Instrument-based diagnostics as needed

Specific Tests for Organs

Skin or oral mucous membrane

Biopsy: histology, immunofluorescence if indicated


Conventional x-ray


Magnetic resonance imaging (MRI)


Creatine kinase



Muscle biopsy



Renal biopsy

Lung and heart

Chest x-ray

Thoracic high-resolution computed tomography (HR-CT)

Lung function test including diffusion capacity

Bronchoalveolar lavage

(Transesophageal) echocardiography

Cardiac catheterization

Cardiac MRI

Myocardial scintigraphy

Coronary angiography


Funduscopy/special investigations in patients on antimalarials

Central and peripheral nervous system


Primarily cranial MRI, special MRI techniques if indicated

Computed tomography

Cerebrospinal fluid analysis

Transcranial Doppler/angiography

Neuropsychiatric examination

Measurement of nerve conduction velocity

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Other Laboratory Tests That Can Indicate Lupus

  • Urine test3— Lupus can attack your kidneys without warning, so a urine test is normally done. Doctors will be on the lookout for proteinuria, which measures the effectiveness of your kidney's ability to filter and eliminate waste.
  • Echocardiogram4 — This test looks for any problems in your heart and its surrounding valves,  via images made by sound.
  • Chest X-ray5 Your lungs can be affected without any warning, so it's vital to have them checked for any inflammation or fluid.

With the various tests presented, it's important to remember that taking and testing positive for only one test is not an immediate indicator of lupus. You need to take various tests to rule out other diseases, and see what abnormal antibodies and proteins remain in your system that can indicate lupus. If other diseases are ruled out, then lupus can be the final diagnosis.


Lupus: Introduction

What Is Lupus?

Lupus Types

Lupus Symptoms

Lupus Causes

Lupus Treatment

Lupus Remedies

Lupus Prevention

Lupus Diet

Is Lupus Hereditary?

Lupus Diagnosis

Living with Lupus

Lupus FAQ

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