D.W. is a 25-year-old married woman with three children under 5 years old. She came to her physician
7 months ago with vague complaints of intermittent fatigue, joint pain, low-grade fever, and unintentional weight loss.
Her physician noted small, patchy areas of vitiligo and a scaly rash across her nose,
cheeks, back, and chest at that time. Laboratory studies revealed that D.W. had a positive antinuclear
antibody (ANA) titer, positive anti-dsDNA test, positive anti-Sm test, elevated C-reactive protein (CRP)
and erythrocyte sedimentation rate (ESR), and decreased C3 and C4 serum complement. Joint x-ray films
demonstrated joint swelling without joint erosion. D.W. was diagnosed with systemic lupus erythematosus (SLE). Her initial treatment consisted of hydroxychloroquine (Plaquenil) 400 mg and prednisone
(Deltasone) 20 mg orally per day, bed rest, and ice packs. D.W. responded well and the steroid was tapered
and discontinued. She was told she could report for follow-up every 6 months unless her symptoms
became acute. D.W. resumed her job in environmental services at a large geriatric facility.
What is the significance of each of D.W.'s laboratory findings?
Positive ANA: A positive ANA titer is the most sensitive test for lupus. It is used as a screening test;
90% of all SLE patients will be positive.
Positive anti-dsDNA and positive anti-Sm: These tests are the most specific to SLE.
Elevated CRP and ESR and decreased C3 and C4: These are nonspecific markers of inflammatory
processes in the body. She has an active inflammatory process.
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