Systemic lupus: initial tests and laboratory monitoring in the community

Fasting laboratory tests (state the clinical context on the request form)

• Antinuclear antibodies (titre and pattern)
• Anti-dsDNA antibodies
• Anti-ENA antibodies (including anti-Sm, anti-SSA, anti-SSB, anti-RNP)
• Complement: CH50, C3 and C4
• FBC
• Serum creatinine with eGFR
• Serum protein electrophoresis
• CRP
• Antiphospholipid antibodies: lupus anticoagulant, anticardiolipin IgG and IgM, anti-beta-2-glycoprotein I IgG and IgM
• Reticulocyte countif neededThe PNDS asks for a blood count with reticulocytes and a direct antiglobulin test, looking in particular for haemolytic anaemia ^[1].
• Direct Coombs testif neededThe PNDS asks for a blood count with reticulocytes and a direct antiglobulin test, looking in particular for haemolytic anaemia ^[1].
• TSHif neededAutoimmune thyroiditis (most often Hashimoto's) is a disease associated with lupus, sought depending on the context ^[1].
• Anti-TPO antibodiesif neededAutoimmune thyroiditis (most often Hashimoto's) is a disease associated with lupus, sought depending on the context ^[1].
• HIV, hepatitis C and parvovirus B19 IgG and IgM serology (if early presentation that may be viral)if neededThe PNDS suggests them to exclude a viral infection that sometimes mimics lupus at onset ^[1].
• Hepatitis B serology (before corticosteroids at immunosuppressive dose, immunosuppressant or biologic therapy)if neededBefore corticosteroids at immunosuppressive dose, an immunosuppressant or a biologic therapy: HIV, hepatitis C and hepatitis B serologies (HBsAg, anti-HBs, anti-HBc) ^[1].
• Fasting plasma glucoseif neededTests before corticosteroids suggested by the PNDS: fasting plasma glucose, lipid profile, serum electrolytes ^[1].
• Lipid profileif neededTests before corticosteroids suggested by the PNDS: fasting plasma glucose, lipid profile, serum electrolytes ^[1].
• Serum electrolytesif neededTests before corticosteroids suggested by the PNDS: fasting plasma glucose, lipid profile, serum electrolytes ^[1].
• Serum β-hCG (if woman of childbearing potential, before treatment)if neededThe pregnancy test is among the tests that prepare for treatment; effective contraception is essential on teratogenic treatment ^[1].

Urine tests

• Urine dipstick (proteinuria, haematuria, leucocyturia)
• Urine protein:creatinine ratio (spot sample)
• Urine microscopy and culture (if haematuria or leucocyturia on dipstick)if neededThe PNDS asks for examination of the urinary sediment (urine microscopy and culture): haematuria, leucocyturia, casts ^[1].

Every 3 to 6 months

• Urine dipstick (proteinuria; if positive, haematuria)
• Urine protein:creatinine ratio (spot sample) (if the dipstick is positive)if neededProteinuria on dipstick is quantified by the spot-sample urine protein:creatinine ratio or 24-hour urine protein ^[1].
• FBC
• Serum creatinine with eGFR
• AST
• ALT
• Alkaline phosphatase
• Complement C3 (and C4)

Every 6 to 12 months

• Anti-dsDNA antibodies

Once a year (if corticosteroids or other risk factor)

• Fasting plasma glucoseif neededGlucose and lipid tests once a year on corticosteroids, tacrolimus or another risk factor, otherwise according to the general-population recommendations ^[1].
• Lipid profileif neededGlucose and lipid tests once a year on corticosteroids, tacrolimus or another risk factor, otherwise according to the general-population recommendations ^[1].

Depending on the context

• Blood hydroxychloroquine (if flare or doubt about adherence; not reimbursed in France for outpatients)if neededThe blood assay helps adjust the dose and assess adherence; the risk of relapse increases below 750 ng/mL ^[1]. It is not reimbursed in community laboratories in France ^[1].
• 25-hydroxyvitamin D (if deficiency suspected, for example sun avoidance or corticosteroid treatment)if needednon-French guidelineThe BSR (2026) recommends daily vitamin D supplementation for everyone all year round, especially in autumn and winter (strong recommendation, level B), and, when judged useful, a level to reinforce supplementation if it is low (level C) ^[4]. The PNDS lists vitamin D deficiency, favoured by sun avoidance, among the risk factors for osteoporosis in lupus, together with corticosteroid therapy ^[1]; the NABM does not cover this test for this indication ^[6].
• Hepatitis B serologyif neededScreening for viral infections in case of an immunosuppressant or a biologic therapy ^[1].
• Hepatitis C serologyif neededScreening for viral infections in case of an immunosuppressant or a biologic therapy ^[1].
• HIV serologyif neededScreening for viral infections in case of an immunosuppressant or a biologic therapy ^[1].

Before pregnancy (preconception visit)

• Antiphospholipid antibodies: lupus anticoagulant, anticardiolipin IgG and IgM, anti-beta-2-glycoprotein I IgG and IgM (if not done or old)
• Anti-SSA and anti-SSB antibodies (if not known)
• Serum creatinine with eGFR
• Urine protein:creatinine ratio (spot sample)
• Rubella serology (if immunity unknown)if neededThe preconception visit checks immunity to rubella, to vaccinate if needed in the absence of contraindication ^[1].

During pregnancy: every month

• Serum creatinine with eGFR
• Urine protein:creatinine ratio (spot sample)
• Complement C3 and C4
• Anti-dsDNA antibodies
• AST
• ALT
• FBC (haemoglobin, platelets)
• Plasma glucose
• Toxoplasmosis serologyif neededThe PNDS includes them in monthly monitoring if they are negative ^[1].
• Rubella serologyif neededThe PNDS includes them in monthly monitoring if they are negative ^[1].
• Urine dipstick and blood pressure at every visit (pre-eclampsia, renal flare).