Teaching Pearls: 

• ANA negative lupus, check SSA/SSB which are associated with neonatal lupus and congenital heart block
• ANA positive in 99% of patients with lupus, but low specificity
• double stranded DNA antibodies are used to monitor disease severity in lupus
• check C3, C4, and double stranded DNA to work up possible lupus flare
• Drug induced lupus: Look for positive ANA and anti-histone antibodies. Also look for exposure to procainamide, hydralazine, chlorpromazine, PTU, phenytoin, minocycline, and TNF inhibitors.