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Systemic lupus erythematosus (SLE) can be difficult to diagnose because:

  • Symptoms are similar to several other diseases
  • There is no single test to identify SLE
  • Symptoms can vary because SLE can affect different areas of the body in different people

SLE may be suspected if at least 4 of the following signs are present with no other apparent reason:

  • Butterfly facial rash over the cheeks and bridge of the nose
  • Presence of discoid lupus erythematosus—chronic rashes, especially on the face and scalp, which can lead to scarring (discoid lupus often leads to SLE)
  • Skin photosensitivity (easily burned by the sun)
  • Ulcers in the mouth or above the back of it
  • Arthritis —swelling, pain, and/or warmth in at least 2 limb joints
  • Inflammation of the lining of the heart ( pericarditis ) or lungs ( pleuritis )
  • Abnormal kidney tests
  • Seizures or psychosis
  • Abnormally low number of blood cells
  • Presence of antinuclear antibodies
  • Evidence of immune dysfunction

Changes in the blood and kidney may be discovered through:

Blood Tests

SLE can cause a variety of changes in the blood that can be different from person to person. Some factors that will be looked for include:

  • Presence of antinuclear antibodies (ANA)—Specific antibodies that attack the contents of your body's cells. These antibodies are believed to be associated with SLE and nearly all people with SLE will test positive.
  • CBC—Measure of all the blood cells.
  • Screen for substances normally filtered out through the kidneys, which shows changes to kidney function
Urine Tests

Presence of proteins, blood, or other substances in the urine may indicate changes in kidney function.


Guidelines for referral and management of systemic lupus erythematosus in adults. American College of Rheumatology Ad Hoc Committee on Systemic Lupus Erythematosus Guidelines. Arthritis Rheum. 1999;42(9):1785-1796.

How is lupus diagnosed? Lupus Foundation of America website. Available at: Updated December 29, 2014.

Lupus. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: Updated May 2013. Accessed December 29, 2014.

Systemic lupus erythematosus (SLE). EBSCO DynaMed website. Available at: Updated November 24, 2014. Accessed December 29, 2014.

Systemic lupus erythematosus (SLE). The Merck Manual Professional Edition website. Available at: Updated October 2013. Accessed December 29, 2014.

Last reviewed May 2015 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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