Essential Diagnostic Tests for Discoid or Cutaneous Lupus
More Programs and Publications Featuring Dr. Kyle Riding
In this program:
For those who may have discoid lupus or cutaneous lupus, which diagnostic tests are essential? Medical laboratory scientist Dr. Kyle Riding discusses diagnostic testing that aid providers in diagnosing patients and what the tests analyze.
Transcript
Deandre White:
And speaking of ANA testing, is it possible that patients who have discoid or cutaneous lupus or that particular type of lupus or have a familial history of cutaneous lupus, let's say if their ANA is negative, what other test should they consider and take to their rheumatologist?
Dr. Kyle Riding:
That's a great question, because the ANA is not perfect, okay? I'm going to say, as a laboratory professional, no lab test is perfect, and it breaks my heart to say that, but it's true. So if you have a family history of discoid or cutaneous lupus, but your ANA is negative, there are still other screening tests that can provide diagnostic clues that should be looked at. The first is a basic complete blood count or a CBC. The lupus and the impact on the immune system can cause alterations in the white blood cell count and the white cell differential that can be suggestive of lupus and give your rheumatologist a clue. Another is, and I'm not the biggest fan of this test, because it doesn't tell us much, but the erythrocyte sedimentation rate or ESR can tell a provider, "Hey, there's definitely systemic inflammation going on here and just because the ANA was negative, don't ignore it." Come back and re-test the ANA later, because ANAs can sometimes disappear and then reappear as the immune system is producing...
Deandre White:
Oh, okay.
Dr. Kyle Riding:
It depends on how active your immune system is at making those antibodies. The other one is urinalysis, actually, a routine urinalysis which can detect any kidney damage that may be happening because of the discoid lupus. The final piece is kind of icky, and it's not exactly the most fun for the patient. But if all else fails, if you as the patient have said to your doc, "Hey, have we done the CBC? How do the white cells look? Hey, have we done the sed rate? How does that look? And how does the urinalysis look?" And there's still not enough evidence, what the physicians can do in discoid lupus is they can actually peel off one of the skin lesions, that's where it's kind of painful and not fun, and they can look at it underneath the lesion in closer detail. And there are certain dermatological changes that can happen in those patients with discoid lupus. So if the lab tests are doing you no good, but you have a family history and you have cutaneous lesions, make sure you have those other non-specific tests done including looking at the lesions themselves.
Deandre White:
Right. That's why it's so important to understand your disease and what tests can be coupled with your disease or better to assess your disease because having cutaneous lupus, it might not even be effective having ANA test, which might have been the only thing that your doctor would've been willing to test you for to begin with. So, yes, advocating for yourself and understanding your disease and what needs to be tested with it.
Dr. Kyle Riding:
Well, and...that's okay. But one of the things with lupus or any autoimmune condition is what I alluded to earlier. We have to remember, it's our own immune system attacking ourselves, and we're only testing for those anti-nuclear antibodies in the blood. But in reality, they could be produced in the tissue spaces, or the immune system could be a little suppressed at the time so the level of those antibodies isn't high enough. And that could explain the negative ANA. We just can't detect it because it's not in the right place, or it's not at a high enough level for us to detect at that time.
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