Laboratory Tests

Symptoms, Signs and Tests

Because many symptoms of systemic lupus erythematosus (SLE) mimic those of other illnesses, lupus can be a difficult disease to diagnose. Diagnosis is usually made by a careful review of three factors:

the individual's entire medical history
an analysis of the results obtained in routine laboratory tests and
some specialized tests related to immune status.
To make a diagnosis of SLE, an individual must show clinical evidence of a multi-system disease (i.e. has shown abnormalities in several different organ systems). Typical symptoms or signs that might lead to suspicion of SLE are:

Skin: Butterfly rash across the cheeks; ulcers in the mouth; hair loss.
Joints: Pain; redness, swelling.
Kidney: Abnormal urinalysis suggesting kidney disease.
Lining membranes: Pleurisy (inflammation of the lining of the lung); pericarditis (inflammation of the heart lining); and/or peritonitis (inflammation around the abdomen). Taken together, these types of inflammation are known as polyserositis.
Blood: Hemolytic anemia (the red cells are destroyed by autoantibodies); leukopenia (low white blood cell count); thrombocytopenia (low number of platelets).
Lungs: Infiltrates (shadowy areas seen on a chest x-ray) that come and go
Nervous system: Convulsions (seizures); psychosis; nerve abnormalities that cause strange sensations or alter muscular control or strength.

If an individual has several of these symptoms, the physician will then usually order a series of tests to examine how well the individual's immune system is functioning. In general, physicians look for evidence of autoantibodies. Although there is no one test that can definitely say whether or not a person has lupus, there are many laboratory tests which aid the physician in making a lupus diagnosis.

Routine clinical tests which suggest that the person has an active systemic disease include:

sedimentation rate (ESR) and CRP (C-reactive protein) binding, both of which are frequently elevated in inflammation from any cause
serum protein electrophoresis which may reveal increased gammaglobulin and decreased albumin
routine blood counts which may reveal anemia and low platelet and white cell counts
routine chemistry panels which may reveal
kidney involvement by increases in serum blood urea nitrogen and creatinine
abnormalities of liver function tests
increased muscle enzymes (such as CPK) if muscle involvement is present.
These kinds of abnormalities alert the doctor to the presence of a systemic disease with multiple organ involvement.

Commonly used blood tests in the diagnosis of SLE are:
Anti-nuclear antibody test (ANA) to determine if autoantibodies to cell nuclei are present in the blood
Anti-DNA antibody test to determine if there are antibodies to the genetic material in the cell
Anti-Sm antibody test to determine if there are antibodies to Sm, which is a ribonucleoprotein found in the cell nucleus
Serum (blood) complement test to examine the total level of a group of proteins which can be consumed in immune reactions
Complement proteins C3 and C4 test to examine specific levels

--------------------------------------------------------------------------------

The Antinuclear Antibody (ANA or FANA) Test

Positive ANA
The immunofluorescent antinuclear antibody (ANA or FANA) test is positive in almost all individuals with systemic lupus (97 percent), and is the most sensitive diagnostic test currently available for confirming the diagnosis of systemic lupus when accompanied by typical clinical findings. When three or more typical clinical features are present, such as skin, joint, kidney, pleural, pericardial, hematological, or central nervous system findings as described above, a positive ANA test confirms the diagnosis of systemic lupus.

However, a positive ANA test, by itself, is not proof of lupus since the test may also be positive in:

other connective tissue diseases, such as:
scleroderma
Sjogren's syndrome
rheumatoid arthritis
thyroid disease
liver disease
juvenile arthritis
individuals being treated with certain drugs, including:
procainamide
hydralazine
isoniazid
chlorpromazine
viral illnesses, such as:
infectious mononucleosis
other chronic infectious diseases, such as:
hepatitis
lepromatous leprosy
subacute bacterial endocarditis
malaria
other autoimmune diseases, including:
thyroiditis
multiple sclerosis
as many as 30-40 percent of asymptomatic first-degree relatives of people with lupus (siblings, parents, and children).
Weakly positive ANA
The test can even be weakly positive in about 20 percent of healthy individuals. While a few of these healthy people may eventually develop lupus symptoms, the majority will never develop any signs of lupus or related conditions. The chances of a person having a positive ANA test increases as he or she ages.

Negative ANA
A negative ANA test is strong evidence against lupus as the cause of a person's illness, although there are very infrequent instances where SLE is present without detectable antinuclear antibodies. ANA-negative lupus can be found in people who have anti-Ro (SSA) or antiphospholipid antibodies.

ANA Titers and Patterns
ANA laboratory reports include a titer (pronounced TY-tur) and a pattern.

The titer indicates how many times the lab technician had to dilute plasma from the blood to get a sample free of the antinuclear antibodies.
For example, a titer of 1:640 shows a greater concentration of anti-nuclear antibodies than a titer of 1:320 or 1:160.
The apparent great difference between various titers can be misleading.
Since each dilution involves doubling the amount of test fluid, it is not surprising that titer numbers increase rather rapidly.
In actuality, the difference between a 1:160 titer and a 1:320 titer is only a single dilution. This does not necessarily represent a major difference in disease activity.
ANA titers go up and down during the course of the disease, and a high or low titer does not necessarily mean the disease is more or less active.
Therefore, it is not always possible to determine the activity of the disease from the ANA titer.
A titer above 1:80 is usually considered positive.
Some laboratories may interpret different titer levels as positive, so one cannot compare titers from different laboratories.


The pattern of the ANA test can sometimes be helpful in determining which autoimmune disease is present and which treatment program is appropriate.
The homogeneous, or smooth pattern is found in a variety of connective tissue diseases, as well as in people taking particular drugs, such as certain antiarrhythmics, anticonvulsants or antihypertensives.
This homogenous pattern is also the one most commonly seen in healthy individuals who have positive ANA tests.
The speckled pattern is found in SLE and other connective tissue diseases
The peripheral, or rim pattern is found almost exclusively in SLE.
The nucleolar pattern, with a few large spots, is found primarily in people who have scleroderma.
Because the ANA is positive in so many conditions, the results of the ANA test have to be interpreted in light of the person's medical history, as well as his or her clinical symptoms. Thus, a positive ANA alone is never enough to diagnose lupus. On the other hand, a negative ANA argues against lupus but does not rule out the disease completely.


A Positive ANA Does Not Equate to Having a Disease
The ANA should be looked at as a screening test. If it is positive in a person who is not feeling well and who has other symptoms or signs of lupus, the physician will probably want to conduct further tests for lupus.

If the ANA is positive in a person who is feeling well and in whom there are no other signs of lupus, it can be ignored. If there is any doubt, a consultation with a rheumatologist should clarify the situation
Other Autoantibodies

In those individuals with a positive ANA, additional tests can be done for certain particular antibodies that may better establish a diagnosis of SLE. The knowledge of which particular antibody is responsible for the positive ANA test can sometimes be helpful in determining which autoimmune disease is present.

Antibodies to DNA (the protein that makes up the body's genetic code) are found primarily in SLE.
Antibodies to histones (DNA packaging proteins) are usually found in people with drug-induced lupus (DIL), but may also be found in those with SLE.
Antibodies to the Sm antigen are found almost exclusively in lupus, and often help to confirm the diagnosis of SLE.
Antibodies to RNP (ribonucleoprotein) are found in a number of connective tissue diseases. When present in very high levels, RNP antibodies are suggestive of mixed connective tissue disease (MCTD), a condition with symptoms like those of SLE, polymyositis, and scleroderma.
Antibodies to Ro/SS-A are found in people with either lupus or Sjogren's syndrome, and are almost always found in babies who are born with neonatal lupus.
Antibodies to Jo-1 are associated with polymyositis.
Antibodies to PM-Scl are associated with certain cases of polymyositis that also have features of scleroderma.
Antibodies to Scl-70 are found in people with a generalized form of scleroderma.
Antibodies to the centromere (a structure involved in cell division) are found in people with a limited form of scleroderma which tends to have a chronic course.

--------------------------------------------------------------------------------

Complement

Laboratory tests which measure complement levels in the blood may also be helpful to the physician in making a diagnosis of SLE.

Complement is a blood protein that destroys bacteria and also influences inflammation.
Complement proteins are identified by the letter "C" and a number.
The most common complement tests are C3, C4, and CH50.
If the total blood complement level is low, or the C3 or C4 complement values are low and the person also has a positive ANA, some weight is added to the diagnosis of lupus. Low C3 and C4 complement levels in individuals with a positive ANA may signify the presence of active disease, especially kidney disease.



--------------------------------------------------------------------------------


Biopsy

Sometimes examination of a tissue sample (biopsy) can be helpful in making a diagnosis. The biopsy is one of the best ways to evaluate an organ or tissue. The procedure involves removal of a small sliver of tissue, which is then examined under a microscope.

The doctor can use the biopsy to identify the amount of inflammation and damage to the tissue.
Further tests can be performed on the specimen to determine whether the problem is due to lupus or is caused by some other factor such as infection or medication.
Almost any tissue can be biopsied. The most common sites biopsied in lupus are the skin and kidney.
The results of the biopsy, like any other laboratory test, should be examined in combination with the individual's medical history and clinical findings.
Tests to Assess Disease Activity

When a person diagnosed with lupus develops new or recurring symptoms, laboratory testing of blood or urine can help determine if the symptoms are due to an increase in lupus activity.

Disease activity correlates with a rise in:

CRP (C-reactive protein) binding
ESR, or sedimentation rate
Anti-DNA
Liver and kidney function tests (AST, ALT, BUN, creatinine)
CPK (muscle enzyme)
Urine protein or cellular casts
Disease activity also correlates with a fall in:

CBC or complete blood count (white blood cell count, hemoglobin, platelets)
Complement components
Serum albumin


--------------------------------------------------------------------------------


Putting It All Together

The interpretation of all these tests, and their relationship to symptoms, can be difficult. When a person has many symptoms and signs of lupus and has positive tests for lupus, it is easier for physicians to make a correct diagnosis and begin treatment. However it is more common for an individual to report vague, seemingly unrelated symptoms of achy joints, fever, fatigue, or pain, and to have negative or borderline test results.

Fortunately, with growing awareness of SLE, an increasing number of physicians will consider the possibility of lupus in the diagnosis. While these tests are useful only when their strengths and limitations are understood, in the hands of skilled physicians these are important tools that assist in diagnosing lupus.

Diagnosis and Treatment of Lupus

While currently there is no cure for lupus, early diagnosis and proper medical treatment can significantly help control the disease. In fact, for most people with lupus, effective treatment can minimize symptoms, reduce inflammation and pain, help maintain normal functions, and stop the development of serious complications.

Just as the symptoms of lupus vary from one individual to another, its treatment is tailored to the different specific problems that arise in each person. The physician will take into account the seriousness and severity of the symptoms and organs involved, the person’s response to treatment as well as her/his age, health, and lifestyle, and the types and risks of potential side effects from the drugs.

The Health Care Team
For mild cases of lupus, when there is little disease activity and no major organ involved, treatment may be managed by a primary care doctor, such as a pediatrician, for children and teens, a family practitioner, or an internal medicine physician, for adults. However, when lupus is active and the person needs to be watched for complications, he or she should be under the care of a specialist, usually a rheumatologist (a physician specially trained to treat musculoskeletal and joint disease).

If lupus has caused damage to a particular organ, other specialists will be consulted as well: a dermatologist for cutaneous lupus (skin disease), a cardiologist for heart disease, a nephrologist for kidney disease, a neurologist for nervous system involvement, and others as the clinical findings require. An obstetrician or perinatologist who specializes in high risk pregnancies will also be needed when a woman with lupus is considering a pregnancy.

Deciding Which Medications to Prescribe
Doctors use a variety of effective medicines to treat their patients. Some of the medications reduce inflammation which causes pain, fever and swelling, while others suppress the overactive immune system. They range in strength from mild to extremely potent, and often several of these medicines are used in combination to control the disease. However, all medications have side effects that need to be monitored.

Although most of the medicines discussed here have not been specifically approved for use in lupus, all appear to be safe and effective for the treatment of symptoms experienced by people with lupus, and have been successfully used for years by doctors in treating their lupus patients.

It is important to note that the medications chosen by physicians to treat lupus will be based on each person’s individual symptoms. These medications prescribed typically change during a person’s lifetime with lupus. It can take months, and sometimes years, before the health care team finds just the right combination of medicines to keep lupus under control.

sakit lagiiii

dari senin kemarin..kayaknnnyakok makin migren terus2n yahhh... sendi2nya juga makin lllinu... tapi yahhh gak apa2 kok.. masihkkuat jalan.even kadang pengen pingsan aja rasana... p nganttukkk...
betis p sakittttt....

godd....

27022008/00.08

hmmmmm... barusan nonton ayat2 cinta ma temen chattingan gue gitu.. hehhee... di traktir buwww makanya gue mau... ehhhh tapijangan blang gue matre yahhh gek juga kok.. lagian dianya yang nawarn.. rezeki masa ditolak. lagian gue gak bisa nonton sm anak2 kamis besok,,,kan mau ada mbak ina. lagian juga kan gue mau ke sardjito.


whuuuuaahhh tes darah lagi kayaknya... takkkuuuuutttssss... takut hasilnya bikin stres dan panik semua orang... haiaaahhhh...
mudah2n tu dokter gmc salah diagnosis. tapi.. masa salah diagnosis hasil tesnya meragukan.. kalo salah diagnosis mah.. negatif atuh ya harusnya...


deuhhhh... lupus....kok nyeremin banget yahhh...

p takuuuttt.. tapi bukan takut sama penyakitnya.. tapi p lebih takuit sama reaksi orang2 di sekitar p..takkut bikin mereka tambah khawatir...
yahhh emmmm...
kalo p pikir2 munkin mmendingan sekali judge aja deyh.. positif atau negatif gittu,,, biar gak bikin semua orang jadi tambah deg2n nunggu hasilnya kaya gini....

p ppenasaran pengen tau siyhhh.... tapi... yahhh.. p takut juga...
hhhhfffuuugggghhhh....

when u're gone

hmmm...

I always needed time on my own
I never thought I'd need you there when I cried
And the days feel like years when I'm alone
And the bed where you lie
Is made up on your side

When you walk away
I count the steps that you take
Do you see how much I need you right now?

When you're gone
The pieces of my heart are missing you
When you're gone
The face I came to know is missing too
When you're gone
The words I need to hear to always get me through the day
And make it ok
I miss you

ternyata

hmmm.. hasil ANA-nya.. anatara negatif dan positif. gak jelas gitu deyh. kata dokternya mesti tetep meical check up lagi minggu depan. fffuihhhhh mana dikash obat lagi..obatnya pait bangeeetttt.. seballllll!!!

pengen nyoba bikin adsense...

Dear....

Hari ini, untuk ke5 kalinya p ke dokter. akhirnya sekarang ke dokter spesialis penyakit dalam...sebelumnya diagnosis dokter saraf artritis.. tapi skarang...katanya lupus ry...
lum pasti siyh... cuma baru diagnosis aja.. dokter minta p buat cek darah... p takut ry...
p ga tau mesti bilang ke siapa... p gak mau bikin ogie atau yang lainnya susah lagi gara2 p...kalo beneran itu lupus...p takut ry....

p

p sayang gie,,, tapi pie gak mau kayak gini terus

hmmmmm.....

lagi pengen nulis siyh.. tapi bingung mu nulis apaa... gak ada ide....
uhmmm.. baru balik kul niyhh tapi ntar kul lagi jam 12. males banget deyh kalo kuliah stengah2 hari ggini..
yah... tapi daripada kul gak ada temen... klo ditanya di kost mu ngapain? ya tidur lah.,.. belakangan jadi sering sakit kepala nih,.gak tau juga kenapa. migren aja kali yah?! tapi beda.. tapi.. ah.. gak tau ah.. sakit kepala aja kok ribet yah..

upzzz... lupa gue belum minum antiobiotik.. out dulu ahh... bye...

baru sampe langsung kuliah.....

haiahhhhh tadi pagi diriq baru sampai dikota ini..(my jogja my city)..tepatnya jam 05.48 WIB...dan langsung tepar ditempat tidur sampe jam10 hehehe...

harusnya bisa lebih pagi sampenya..kalo aja semalem gue gak ketinggalan kereta..hohoho..
yupzzz gue ketinggalan kereta 1 jam. parah banget! untuk masih ada kereta yang lain. kalo gak gawat aja kalo gue mesti naek ekonomi. gilingin.. bawaan gue seabrek2 gitu...
officiallynya bawaan gue cuma 1 tas ransel item doang. gak gede2 banget. eh.. Nyak tersayang bawain gue macem2 gitu dah. gue kaget pas buka tas gue yang satu lagi which is prepared by her... tau gaksiyh isinya....:

• keripik pisang +loncis...(tau gak?)
• ayam goreng
• ikan teri+bandeng
• abon sapi
• gula merah.. (????)
• air putih 2 botol
• sabun cuci piring (??)
• abu gosok...(?????????????????)
• beras+nasi

udah kayak mu kemping aja gue..hohoho...

mpe kos'n langsung tidur..kebangun gara2 ada yang sms (gue gak tau itu sapa...)nanya.. "pit kuliah jam berapa?" haiaaahhhh..nyawa gue aja lum ngumpul...gue bangun... bongkar2 tas... trus ada sms lagi.. "Dek ku jemput 10 menit lagi.." waduhhhhh..parah... belum ngaapa2in lagi...
gue langsung mandi n capcussss ke kampus..kalo gak gue bisa ditinggal and gue mesti ke kampus jalan kaki.. walaaahhhh tidak lah yawww....kakiku masih belum bisa kompromi jalan jauh.. ( :) )... hmmm... apa lagi yah....?????

for her my rival's shaddow...

actually it's none of my business..i just dont know what probably really happened between u both in d past. i should be dont really care bout this. i see this is a past. it's just doesn't matter . but then i thought (the same thought as i was before...) i should know what really happened. why are 'them' shut up? why them not just tell me? i won't cry loud. maybe just some tears. but that's all. i need an honesty even i scared of the hurt feeling's after.
only God who know the truth of what happened between u and gie.i just think that might be something or maybe lots of things that i don't know.
i don't know who would tell me. gie's just to sensitive to talk about you. i don't want we fight again because of this. i don't want he remember or repeating the same things again. but i don't know how to do that? just leave at all... ?? it won't work..
for u to know. it's not about me who said that "don't love her" it wasn't, it's already established "don't say that about her".
i'm not scared of loosinghim. i won't. but i'm scared that i'm going tired an give up. i'm scared to hurt him on my way. but mostly,i'm scared that i loose this fight. the fight ini gie's mind between me and ur shaddow.