What to Expect When You See the Rheumatologist
If your doctor does refer you to arheumatologistbecause he or she suspects lupus, patients can expect a thorough medical history and complete physical examination, as well as several laboratory tests, says Kramer.
There’s no onetest for lupus, so therheumatologistwill typically use a combination of test results and the signs and symptoms you report to make a diagnosis, addsFrancisLuk, MD,, an assistant professor in the Wake Forest School of Medicine department of internal medicine, section of rheumatology, in Winston-Salem, North Carolina.
Symptoms are subjective and include pain levels and how much fatigue a person is experiencing. Signs are measurable and can include rash or swelling of the joints, he says.
Lab Tests the Doctor Might Ru
For lab tests, a blood draw for a complete blood count, which measures levels of the red blood cells, white blood cells, and platelets is standard, says Kramer. Notably, these blood cell levels may be low in people with lupus. (1)
Aurinalysis, a test of the urine, is also standard for assessing kidney function, says Kramer. Bits of cells called cell casts and large or abnormal amounts of protein in the urine are signs that the kidneys are not doing their job of filtering waste from the blood properly. Inflammation of the kidneys, or lupus nephritis, is a complication of lupus, too; these are all things doctors are on the lookout for. (1)
Rheumatologists also look for certain antibodies, or proteins, in your blood to help diagnose lupus, says Kramer. In healthy people, antibodies fight off foreign invaders such as viruses, bacteria, and fungi. People with lupus produce autoantibodies, which are antibodies that attack the body’s own cells and tissues. (2) Laboratory tests check for the following:
- Antinuclear Antibodies (ANA)These proteins bind to the cell nucleus, damaging the cell or causing it to die. About 97 percent of people with lupus have these antibodies. (1)
- Anti-Double-StrandedDNAAntibodies These proteins are a type of anti-nuclear antibody that bind to the DNA, or genetic material, inside the cell nucleus. About half of people with lupus have these antibodies. (3)
- Antibodies to SmThese antibodies target proteins called Sm in the cell nucleus. This antibody type is present in up to 40 percent of people with lupus. (3)
- Antiphospholipid AntibodiesThese antibodies can cause narrowing of the blood vessels. About a third of people with lupus test positive for antiphospholipid antibodies. (3)
- Complement ProteinsThese proteins boost the body’s immune response to infections. The inflammation thatlupus causes can lead to low complement levels, which is why your rheumatologist might run tests of your levels to help identify lupus. (3)
Other Medical Tests That HelpRheumatologistsDiagnose Lupus
Other tests for lupus can depend on the symptoms patients are experiencing, saysStuart Kaplan, MD, a rheumatologist at Mount Sinai South Nassau in Oceanside, New York. For example, chest X-rays and echocardiograms may be necessary to indicate whether a patient has pleuritis or pericarditis if individuals have chest pain or shortness of breath (both symptoms indicate those conditions might be happening). If doctors suspect nephritis is present, the patient may need a kidney biopsy, he says.
