Medical History and Physical Exam for Lupus

A physical exam for suspected Reference lupus Opens New Window (systemic lupus erythematosus, or SLE) includes a thorough check of your skin, joints, lungs and breathing, nervous system, and heart.

The medical history includes questions about:

• Reference Arthritis Opens New Window, joint, or muscle pain.
• Weight loss or fatigue.
• Skin rashes, especially after exposure to sunlight.
• Sores in the mouth, nose, or other mucous membranes.
• Chest pain.
• Hair loss or thinning.
• Reference Seizures Opens New Window, convulsions, or other Reference nervous system Opens New Window symptoms.
• Whether anyone in your family has lupus.
• Whether you have ever had kidney disease.

A physical exam and medical history are done to evaluate symptoms. The parts of the body that are examined, and the questions that are asked, depend on which diseases your doctor suspects or thinks are most likely.

Your doctor will use certain criteria to distinguish lupus from other Reference autoimmune Opens New Window and rheumatic diseases. You may have all of the lupus-related conditions at once, or you may experience them over a period of time.

Classification criteria for systemic lupus erythematosus:^{Reference 1}

• Reference Butterfly (malar) rash Opens New Window Reference Opens New Window on cheeks
• Rash on face, arms, neck, torso (discoid rash)
• Skin rashes that result from exposure to sunlight or ultraviolet light (photosensitivity)
• Mouth or nasal sores (Reference ulcers Opens New Window), usually painless
• Joint swelling, stiffness, pain in two or more joints (arthritis)
• Inflammation of the membranes surrounding the lungs (pleuritis) or heart (pericarditis)
• Abnormalities in urine, such as increased protein or clumps of red blood cells or kidney cells, called cell casts
• Nervous system problems, such as seizures or Reference psychosis Opens New Window, without known cause
• Problems with the blood, such as reduced numbers of red blood cells (anemia), platelets, or white blood cells
• Laboratory tests showing increased Reference autoimmune Opens New Window activity (antibodies against normal tissue)
• Positive antinuclear antibody (ANA) test

If you have at least 4 of these 11 conditions, you likely will be classified as having lupus.

Lupus is hard to diagnose, because its symptoms are similar to those of many other disorders. A few nonspecific symptoms may persist for years before other problems develop.

When classic lupus symptoms develop quickly, lupus can be more easily diagnosed. If the symptoms are nonspecific or occur off and on, or if test results are inconclusive, it may take months or even years to make a definite diagnosis.

Complete the medical test information form (PDF) (What is a Reference PDF Opens New Window document?) to help you prepare for this test.

Citations

1. Hahn BH (2012). Systemic lupus erythematosus. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 2, pp. 2724–2735. New York: McGraw-Hill Medical.

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