American College of Rheumatology Criteria for diagnosis [modified]
* Antinuclear Antibodies (ANA)- ≥1:160 Sensitive ! >1:640 fairly Specific
And ≥3 of the Following (perhaps even ≥4, without the ANA)
* Malar Rash [see pictures below]- Fixed erythema over cheekbones
- Spares nasolabial folds
- Red, raised, scaly patches
* Photosensitivity
* Oral / Nasal Ulcers (usually painless)- Observed objectively
- ≥2 joints, objectively observed
- Pleuritis (friction rub/effusion/good Hx of episodic pleuritic CP)
- Pericarditis (friction rub / EKG changes / echo)
* Seizure OR Psychosis
* Cytopenias on the CBC (any of following):- Anemia (hemolytic, w/ reticulocytosis)
- Lymphopenia: <1500 absolute Lymphs on 2 occasions
- Leukopenia: <4000 WBCs on 2 occasions
- Platelets: <100,000
- >3+ Protein (persistent)
- Casts
- Anti-ds DNA
- Anti-Smith
- Anti-Phospholipid Abs
- False + RPR [x6 months, confirmatory test negative)
- ↓ C3 and C4 common (not part of diagnostic paradigm)
- Positive renal biopsy diagnostic
- Dx Criteria ? more useful in research vs. clinical
- Pts develop additional Sx over time
See posting Polyarthralgias.
PICTURES:
Malar Rash [NOTE: does Not cross nasolabial fold]
Discoid Rash