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Management of Systemic Lupus Erythematosus

           test and ELISA tests for anticardiolipin antibodies (aCL) and anti-beta-
           2-glycoprotein 1 (anti-β2GP1). In SLE, 30 - 40% of patients are positive
           for aPL. 27, level II-2; 28, level III
           The presence of aPL is incorporated as an immunologic domain for
           classification of SLE. The aPL includes: 23; 29, level III
               aCL  antibodies  (immunoglobulin  A  [IgA],  immunoglobulin  G
                [IgG] or immunoglobulin M [IgM]) at medium or high titre (>40 A
                phospholipids [APL], G phospholipids [GPL] or M phospholipids
                [MPL] units, or >99  percentile)
                               th
               anti-β2GP1 (IgA, IgG or IgM)
               LA
           In antiphospholipid syndrome (APS), two tests with a minimum interval
           of 12 weeks are necessary in order to exclude short-term IgM antibodies
           following a vascular event or an infection. 30, level III

           •   Complements
           Complement  activation  is  a  key  event  in  the  pathogenesis  of  tissue
           inflammation  and  injury  in  SLE  patients  where  decreased  levels  of
           C3 and C4 are detected along with disease activity. However, serum
           complement levels can be affected by various physiological conditions
           e.g.  infections,  traumatic  damage  or  immunosuppressants,  and  not
           only in patients with autoimmune diseases but healthy individuals. 31,
           level III; 32, level III

           Apart from above, further investigations will depend on the symptoms
           of SLE that are present. 33, level III

           Recommendation 1
           •  The  following  tests  should  be  done  to  assist  in  the  diagnosis  of
             systemic lupus erythematosus (SLE):
               full blood count with differential counts
               renal profile
               liver function test
               urinalysis
               erythrocyte sedimentation rate with/without C-reactive protein
               antinuclear antibodies and anti-double stranded deoxyribonucleic
                acid
               complement 3 and complement 4
           •  All patients with SLE should be screened for  antiphospholipid
             antibodies at diagnosis.







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