EVALUATION OF THREE DIAGNOSTIC PROCEDURES FOR SYSTEMIC LUPUS ERYTHEMATOSUS

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Abstract
Three methods for inducing the lupus erythematosus (LE) phenomenon were compared from the various aspects of sensitivity, accuracy, facility, availability of controls, and the occurrence of false positive and false negative results. All 3 procedures were found to be positive in classic examples of severe systemic LE, except for occasional false negative results in the patient''s own bone marrow procedure. (This was due presumably to the occasional hypoplastic marrows associated with the disease.) The difference between the 3 LE tests was more apparent in patients with low-grade illness; or the so-called "lupus diathesis". In this group the peripheral blood LE test (clotted) was the most sensitive, the patient''s own marrow LE test the next, and the plasma-dog bone marrow LE test the least sensitive. Of 33 such patients followed up to 3 years, all were living, suggesting that a positive LE test by itself is not necessarily of serious prognostic importance. A survey was made of 20 hematologists, selected by geographic location as well as because of a special interest in hematology. In general, the LE tests were specific. False negative LE tests were not infrequent in the face of typical systemic LE but false positive LE tests, such as in penicillin sensitivity, were not reported. Positive LE tests in apresoline reactors were not considered to be "false positive" due to the close clinical resemblance with systemic LE. The clotted peripheral blood LE test and the plasma - bone marrow LE test were found to have special advantages. A combination of both is suggested as a practical office procedure.

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