No single test can diagnose lupus, but a collection of tests can rule out other disorders. This process can take months or years and may require self-advocacy.

Lupus is a chronic autoimmune condition that causes symptoms such as joint pain, fatigue, and skin lesions. The condition can be difficult to diagnose because these symptoms are shared with many other conditions.

Lupus is often diagnosed in people between 15 and 44 years old. It’s also more commonly seen in people assigned female at birth, though people assigned male at birth can also develop lupus.

Often, getting a lupus diagnosis can take years. That’s because no single test can confirm a diagnosis of lupus, though a couple of tests may strongly indicate lupus.

A doctor will start by discussing your symptoms. You’ll review your medical history and any conditions, especially autoimmune disorders, in your family. The doctor may need to rule out several other conditions before confirming a lupus diagnosis.

Read on to learn more about what to expect and how to advocate for yourself.

A doctor will ask you to describe your symptoms. They will also do a complete physical exam and examine your skin for skin lesions and rashes. Skin lesions and rashes are commonly seen in people with lupus.

In addition to learning more about your symptoms, a doctor may use the following tests to help them make a diagnosis:

  • Urine tests: Urine tests can be performed to look for protein, blood, and other cells in the urine. If present, this may indicate inflammation of the kidneys from lupus.
  • Blood tests: Blood tests can look for levels of blood cells, proteins, and antibodies in your blood. Many people with lupus have an antibody called the antinuclear antibody (ANA) in their blood. A positive ANA test doesn’t always mean a person has lupus, but it helps doctors get closer to confirming a diagnosis.
  • Skin biopsy: A skin biopsy is a procedure that removes a small tissue sample from a lesion on your skin. This sample will be studied in a lab for signs of lupus. This may not be needed if you have the typical “butterfly rash” that’s often seen in those with lupus.
  • Kidney biopsy: Sometimes, a kidney biopsy is performed so that kidney tissue can be seen up close and inspected for signs of autoimmune disease.

A wide variety of criteria are considered during a lupus diagnosis. The 2019 European League Against Rheumatism criteria even mandated that you need to have a positive ANA result before the diagnosis of lupus is even considered.

These criteria look at the health of your organs, muscles, blood, and more. Each category receives a score, and the total score determines the probability of having lupus. ANA antibodies, autoimmune damage to the skin and kidneys, and a history of lupus symptoms are generally enough to confirm a diagnosis.

However, these criteria are guidelines and not absolute for diagnosis. Your doctor may also use different diagnostic criteria depending on the type of lupus.

There are four main types of lupus:

  • Systemic lupus erythematous (SLE): SLE is the most common type of lupus. Typically, when people use the term “lupus,” they’re referring to SLE.
  • Cutaneous lupus: This type of lupus affects the skin, and is further broken down into three subtypes: chronic cutaneous lupus erythematosus (CCLE), acute cutaneous lupus erythematosus (ACLE), and subacute cutaneous lupus erythematosus (SCLE).
  • Drug-induced lupus erythematosus: Drug-induced lupus erythematosus is a rare, temporary form of lupus caused by certain medications. Most of the drugs that can cause drug-induced lupus erythematosus are prescribed less commonly today than in the past.
  • Neonatal lupus erythematosus: Neonatal lupus erythematosus is a condition passed on in the womb. Children with neonatal lupus erythematosus are at increased risk of heart block and other serious heart conditions.

Cutaneous lupus

In addition to results from the tests listed above, CCLE is typically diagnosed after a skin biopsy. Tests such as biopsies won’t help determine whether a skin lesion is caused by SLE or drug-induced lupus erythematosus.

Drug-induced lupus erythematosus

If you’re taking a medication with a known link to drug-induced lupus erythematosus, part of the diagnostic process might be stopping that medication. If your symptoms stop, that can confirm the diagnosis and resolve your drug-induced lupus erythematosus.

Neonatal lupus erythematosus

Neonatal lupus erythematosus is rare, but today, at-risk pregnancies, such as pregnancies of people who have SLE, can be monitored closely. Neonatal lupus erythematosus can often be diagnosed before birth.

An unborn baby can be monitored in the womb, and further testing can be done if a weak heartbeat is detected. Treatment can be given before birth or immediately after birth to reduce the risk of heart-related complications.

An unborn baby’s heart can be monitored in the womb with echocardiograms, and the birth-parent’s blood can be tested for anti-Ro/SSA and anti-La/SSB antibodies to confirm the diagnosis if a weak heartbeat has been detected.

It’s most common symptoms of lupus begin when someone is between 15 and 44 years old. However, some people with SLE are diagnosed with what’s known as late-onset lupus. Late-onset lupus symptoms typically begin at around age 59. Symptoms can be vague and easy to mistake for simple symptoms of aging.

Even doctors sometimes mistake late-onset lupus for types of arthritis or other autoimmune conditions. However, the overall diagnostic process is the same. Your symptoms, along with urine testing, bloodwork, and biopsies, will all be reviewed by a doctor to help confirm a diagnosis.

How long does it take to diagnose lupus?

There can be years between the first lupus symptom appearing and the final diagnosis being confirmed.

Healthcare professionals sometimes call lupus an “imitator” because the symptoms of lupus are similar to those of many other conditions. This can make lupus difficult to diagnose. It often takes a long time to get a lupus diagnosis.

How hard is it to diagnose lupus?

A rheumatologist who specializes in lupus should be able to diagnose the lupus. But, for doctors who are less familiar with lupus, it can be difficult to diagnose.

There isn’t a specific test that can prove lupus, and its symptoms are shared with many other chronic conditions. Doctors might need to rule out several possibilities before determining whether lupus is the answer.

A primary care doctor may be able to order an ANA screening test, but referral to a rheumatologist will be important to confirm the diagnosis. Don’t be afraid to advocate for yourself if you need a referral to a rheumatologist or if you cannot get testing for lupus.

Who is most likely to get lupus?

Anyone can get lupus, but there are known risk factors that are linked to the condition. These include:

  • being female
  • being in your 20s or 30s
  • being African American or of Asian decent
  • having a family history of lupus
  • having a family history of any autoimmune disease

While most of the people who get lupus are female, males tend to get especially severe forms of the disease.

Learn more about the causes of lupus.

Lupus can be difficult to diagnose because the condition has symptoms that overlap with others. This can make lupus present as a different condition and can delay the diagnostic process.

Additionally, there’s no single test that can diagnose lupus. Instead, a physical exam, and results from a urine test, blood test, and biopsy will all be looked at together to confirm a diagnosis. In some cases, this can take years of trial and error as other conditions are eliminated as possibilities.

If lupus is suspected, it’s important to see a rheumatologist as soon as possible to confirm the diagnosis. Medications that reduce the overactive immune response in lupus can then be prescribed. It’s important to start treatment as early as possible to avoid long-term complications like organ damage.