Endoscopy is warranted in patients who have upper gastrointestinal symptoms unresponsive to treatment. Bone marrow biopsy and biochemical tests are required for the diagnosis of systemic mastocytosis in patients without skin involvement. The risk of associated malignant disease in adults with mastocytosis ranges from 2 percent in those with only urticaria pigmentosa 9 to 70 percent in elderly symptomatic patients with systemic mastocytosis and no skin lesions. 12 The role of periodic surveillance is uncertain, but it may be useful to obtain a complete blood count regularly.
While the genetics of SLE are not very well understood, there is growing evidence for the involvement of specific genes in this complex autoimmune disease . Part of the complexity of this disease is due to the effects of both environment and genetics factors that may contribute to its development.  Further compounding our understanding of the etiology of the disease is the involvement of several organ systems.  Genetic studies of the rates of disease in families supports the genetic basis of this disease with a heritability of >66%.  Identical ( monozygotic ) twins were found to share susceptibility to the disease at >35% rate compared to fraternal ( dizygotic ) twins and other full siblings who only showed a 2–5% concordance in shared inheritance. 
Testing for antibody to double-stranded DNA antigen (anti-dsDNA) and antibody to Sm nuclear antigen (anti-Sm) may be helpful in patients who have a positive ANA test but do not meet full criteria for the diagnosis of systemic lupus erythematosus. AntidsDNA and anti-Sm, particularly in high titers, have high specificity for systemic lupus erythematosus, although their sensitivity is low. Therefore, a positive result helps to establish the diagnosis of the disease, but a negative result does not rule it out. 46 The CAP guideline recommends against testing for other autoantibodies in ANA-positive patients, because there is little evidence that these tests are of benefit. 46