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LIVING WITH LUPUS: DOCTOR AND PATIENT - A PLAN OF ACTION—OR INACTION
There is a cardinal principle of the practice of medicine which is learned by every future physician in medical school, faithfully observed by most, but unfortunately occasionally forgotten by a few: Primutn non nocere. This Latin phrase means, "First of all, do no harm." In lupus, in which severely disruptive drugs must sometimes be used to control or dispel severely destructive or debilitating disease processes, this prime directive translates into, "Treat the patient, not the lab tests— and don't overtreat"
Laboratory tests do play an initially important part in establishing the existence of lupus, basically confirming a diagnosis the experienced rheumatologist has made on the basis of examining and talking with the patient. Mainly, lab tests rule out other conditions—malignancies, endocrine-gla'nd diseases, specific organ dysfunctions—requiring very different treatment. They also establish baseline values for later comparison.
Beyond those roles, lab tests are not necessarily terrific predictors of treatment needs.
The aim is to keep the patient as healthy as possible—which, means, essentially, two things: controlling and relieving symptoms that interfere with the quality of life; and preventing and coping with critically threatening complications, such as kidney disease. Lab-test results are not always indicative of the patient's status in either sense.
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