The British Society for Rheumatology Guideline for the Management of Systemic Lupus Erythematosus in Adults

Caroline Gordon; Maame-Boatemaa Amissah-Arthur; Mary Gayed; Sue Brown; Ian N. Bruce; David D'Cruz; Benjamin Empson; Bridget Griffiths; David Jayne; Munther Khamashta; Liz Lightstone; Peter Norton; Yvonne Norton; Karen Schreiber; David Isenberg


Rheumatology. 2018;57(1):e1-e45. 

In This Article

Recommendations for Clinical and Serological Features Prompting Consideration of a Diagnosis of SLE

  1. SLE is a multisystem autoimmune disorder. The diagnosis requires a combination of clinical features and the presence of at least one relevant immunological abnormality. If there is a clinical suspicion of lupus, blood tests (including serological marker tests) should be checked (LOE 2 ++, GOR B, SOA 98%).

  2. ANAs are present in ~95% of SLE patients. If the test is negative, there is a low clinical probability of the patient having SLE. A positive ANA test occurs in ~5% of the adult population, and alone it has poor diagnostic value in the absence of clinical features of autoimmune rheumatic disease (2 ++/B, SOA 96%).

  3. The presence of anti-dsDNA antibodies (2 ++/B), low complement levels (2+/C) or anti-Smith (Sm) antibodies (2+/C) are highly predictive of a diagnosis of SLE in patients with relevant clinical features. Anti-Ro/La and anti-RNP antibodies are less-specific markers of SLE (2+/C) as they are found in other autoimmune rheumatic disorders as well as SLE (2+/C) (SOA 95%).

  4. aPLs should be tested in all lupus patients at baseline, especially in those with an adverse pregnancy history or arterial/venous thrombotic events (2 ++/B). Confirmatory tests for APS are positive LA, aCL (IgG, IgM) and/or anti-beta-2 glycoprotein-1 (IgG, IgM) on two occasions at least 12 weeks apart (2 ++/B) (SOA 97%).