Kikuchi disease differential diagnosis: Difference between revisions

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{{Kikuchi disease}}
{{Kikuchi disease}}
{{CMG}}
{{CMG}} ; {{AE}} {{MIR}}


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==Overview==
==Differentiating Kikuchi disease from other Diseases==
Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting disorder that typically affects the cervical [[lymph node]]s. Recognition of this condition is crucial, especially because it can easily be mistaken for [[disseminated tuberculosis]], [[lymphoma]], [[SLE]], [[sarcoidosis]], [[viral]] [[lymphadenitis]] or even [[adenocarcinoma]]. Awareness of this disorder will help prevent misdiagnosis and inappropriate treatment.<ref name="PMID22762705">{{cite journal |author=Rammohan A, Cherukuri SD, Manimaran AB, Manohar RR, Naidu RM|title=Kikuchi-Fujimoto Disease: A Sheep in Wolf's Clothing |journal=J Otolaryngol Head Neck Surg|volume=41 |issue=3 |pages=222–226 |year=2012 |month=June|pmid=22762705|}}</ref>
Kikuchi disease is a rare, [[self-limiting]] [[disorder (medicine)|disorder]] that typically affects the [[cervical lymph nodes]]. Recognition of this condition is crucial, especially because it can easily be mistaken for:
*[[Disseminated tuberculosis]]
*[[Lymphoma]]
*[[SLE]]
*[[Sarcoidosis]]
*[[Viral]] [[lymphadenitis]]
*[[Adenocarcinoma]].


Awareness of this disorder will help prevent [[misdiagnosis]] and inappropriate treatment.<ref name="PMID22762705">{{cite journal |author=Rammohan A, Cherukuri SD, Manimaran AB, Manohar RR, Naidu RM|title=Kikuchi-Fujimoto Disease: A Sheep in Wolf's Clothing |journal=J Otolaryngol Head Neck Surg|volume=41 |issue=3 |pages=222–226 |year=2012 |month=June|pmid=22762705|}}</ref>
===== Differentiating Kikuchi disease from other diseases that may cause [[arthritis]] and [[rash]]=====
<span style="font-size:85%">'''Abbreviations:'''
'''ANA:''' [[Anti-nuclear antibody|Antinuclear antibody]], '''RF:''' [[Rheumatoid factor]], '''Anti-CCp:''' [[Anti-citrullinated protein antibody|Anti-cyclic citrullinated protein antibody]], '''Anti U1RNP:''' Anti-U1 ribonucleoprotein antibodies , '''Anti Sm :''' Anti-Sm antibodies, '''Anti Ro:''' Anti Ro antibody also called anti-Sjögren's-syndrome-related antigen A antibody, '''Anti-dsDNA:''' [[Anti-dsDNA antbodies|Anti-double stranded DNA]].
</span>
<small>
{| class="wikitable"
! colspan="2" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
! colspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" |Arthritis
! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" |Auto-antibodies
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Raynaud phenomenon
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Rash pattern
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |Distinguishing/specific features
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" |Polyarthritis
! align="center" style="background:#4479BA; color: #FFFFFF;" |Tenderness
! align="center" style="background:#4479BA; color: #FFFFFF;" |Edema
! align="center" style="background:#4479BA; color: #FFFFFF;" |Deformity /Erosion
! align="center" style="background:#4479BA; color: #FFFFFF;" |Pattern
! align="center" style="background:#4479BA; color: #FFFFFF;" |ANA
! align="center" style="background:#4479BA; color: #FFFFFF;" |RF
! align="center" style="background:#4479BA; color: #FFFFFF;" |Anti-CCp
! align="center" style="background:#4479BA; color: #FFFFFF;" |Anti U1RNP
! align="center" style="background:#4479BA; color: #FFFFFF;" |Anti Sm
! align="center" style="background:#4479BA; color: #FFFFFF;" |Anti Ro
! align="center" style="background:#4479BA; color: #FFFFFF;" |Anti-dsDNA
|-
| colspan="2" align="center" style="background:#DCDCDC;" |[[Kikuchi's Disease|Kikuchi’s disease]]<ref name="pmid16538388">{{cite journal |vauthors=Kucukardali Y, Solmazgul E, Kunter E, Oncul O, Yildirim S, Kaplan M |title=Kikuchi-Fujimoto Disease: analysis of 244 cases |journal=Clin. Rheumatol. |volume=26 |issue=1 |pages=50–4 |year=2007 |pmid=16538388 |doi=10.1007/s10067-006-0230-5 |url=}}</ref>
| -
|<nowiki>+/-</nowiki>
| -
| -
|medium and large joints
|↑/↓
| -
| -
| -
| -
| -
| -
| -
|Transient skin [[rashes]], [[malar rash]], [[Macule|erythematous macules]], patches, [[papules]], or [[plaques]]
|May be associated with SLE
|-
| colspan="2" align="center" style="background:#DCDCDC;" |[[Systemic lupus erythematosus]]<ref name="pmid25074031">{{cite journal |vauthors=Ehmke TA, Cherian JJ, Wu ES, Jauregui JJ, Banerjee S, Mont MA |title=Treatment of osteonecrosis in systemic lupus erythematosus: a review |journal=Curr Rheumatol Rep |volume=16 |issue=9 |pages=441 |year=2014 |pmid=25074031 |doi=10.1007/s11926-014-0441-8 |url=}}</ref>
| align="center" |<nowiki>+</nowiki>
| align="center" |<nowiki>+</nowiki>
| align="center" |<nowiki>+</nowiki>
| align="center" |<nowiki>-</nowiki>
| align="center" |Small joints
| align="center" |↑
| align="center" |<nowiki>-</nowiki>
| align="center" |<nowiki>-</nowiki>
| align="center" | -
| align="center" |↑
| align="center" |↑
| align="center" | -
| align="center" |<nowiki>+</nowiki>
|[[Malar rash]] and [[photosensitivity]]
|
|-
| colspan="2" align="center" style="background:#DCDCDC;" |[[Rheumatoid arthritis]]  ([[Rheumatoid arthritis|RA]])<ref name="pmid11567728">{{cite journal |vauthors=Lee DM, Weinblatt ME |title=Rheumatoid arthritis |journal=Lancet |volume=358 |issue=9285 |pages=903–11 |year=2001 |pmid=11567728 |doi=10.1016/S0140-6736(01)06075-5 |url=}}</ref>
| align="center" | +
| align="center" | +
| align="center" | +
| align="center" | +
| align="center" |Small and large joints
| align="center" |<nowiki>-</nowiki>
| align="center" |↑↑
| align="center" |↑↑
| align="center" |<nowiki>-</nowiki>
| align="center" |<nowiki>-</nowiki>
| align="center" | -
| align="center" | -
| align="center" | +
|[[Subcutaneous]] [[nodules]]
|Erosive [[arthropathy]]
|-
| colspan="2" align="center" style="background:#DCDCDC;" |Rhupus<ref name="pmid3382309">{{cite journal |vauthors=Panush RS, Edwards NL, Longley S, Webster E |title='Rhupus' syndrome |journal=Arch. Intern. Med. |volume=148 |issue=7 |pages=1633–6 |year=1988 |pmid=3382309 |doi= |url=}}</ref>
| align="center" | +
| align="center" | +
| align="center" | +
| align="center" | +
| align="center" |Small and large joints
| align="center" |↑
| align="center" |↑
| align="center" |↑
| align="center" |↑
| align="center" |↑
| align="center" |<nowiki>-</nowiki>
| align="center" |↑
| align="center" | +
|[[Malar rash]] and [[photosensitivity]]
|Erosive [[arthropathy]]
|-
| colspan="2" align="center" style="background:#DCDCDC;" |[[Mixed connective tissue disease]] (MCTD)<ref name="pmid21959290">{{cite journal |vauthors=Cappelli S, Bellando Randone S, Martinović D, Tamas MM, Pasalić K, Allanore Y, Mosca M, Talarico R, Opris D, Kiss CG, Tausche AK, Cardarelli S, Riccieri V, Koneva O, Cuomo G, Becker MO, Sulli A, Guiducci S, Radić M, Bombardieri S, Aringer M, Cozzi F, Valesini G, Ananyeva L, Valentini G, Riemekasten G, Cutolo M, Ionescu R, Czirják L, Damjanov N, Rednic S, Matucci Cerinic M |title="To be or not to be," ten years after: evidence for mixed connective tissue disease as a distinct entity |journal=Semin. Arthritis Rheum. |volume=41 |issue=4 |pages=589–98 |year=2012 |pmid=21959290 |doi=10.1016/j.semarthrit.2011.07.010 |url=}}</ref>
| align="center" |<nowiki>-</nowiki>
| align="center" | -
| align="center" | -
| align="center" | +
| align="center" |Small and large joints
| align="center" |<nowiki>-</nowiki>
| align="center" |↑↑
| align="center" |↑
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | +
|Cutaneous eruptions, [[Gottron's papules|gottron’s papules]], photodistributed [[erythema]], [[Poikiloderma of civatte|poikiloderma]], and [[calcinosis cutis]]
|Overlapping features of SLE, [[systemic sclerosis]] (SSc), and [[polymyositis]] (PM) that lead to more than one diagnosis
|-
| colspan="2" align="center" style="background:#DCDCDC;" |[[Undifferentiated connective tissue disease]] (UCTD)<ref name="pmid1757934">{{cite journal |vauthors=Alarcón GS, Williams GV, Singer JZ, Steen VD, Clegg DO, Paulus HE, Billingsley LM, Luggen ME, Polisson RP, Willkens RF |title=Early undifferentiated connective tissue disease. I. Early clinical manifestation in a large cohort of patients with undifferentiated connective tissue diseases compared with cohorts of well established connective tissue disease |journal=J. Rheumatol. |volume=18 |issue=9 |pages=1332–9 |year=1991 |pmid=1757934 |doi= |url=}}</ref>
| align="center" | +
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" |Lower extremity
| align="center" |↑
| align="center" |↑
| align="center" | -
| align="center" | -
| align="center" |↑
| align="center" | -
| align="center" | -
| align="center" | +
|[[Erythematous]] [[macules]], patches, or [[papules]] with delicate scale
|Multiple connective tissue diseases with no enough criteria for a single diagnosis
|-
| colspan="2" align="center" style="background:#DCDCDC;" |[[Systemic sclerosis]] (SSc)<ref name="pmid3361530">{{cite journal |vauthors=LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA, Rowell N, Wollheim F |title=Scleroderma (systemic sclerosis): classification, subsets and pathogenesis |journal=J. Rheumatol. |volume=15 |issue=2 |pages=202–5 |year=1988 |pmid=3361530 |doi= |url=}}</ref>
| align="center" |<nowiki>+/-</nowiki>
| align="center" |<nowiki>+</nowiki>
| align="center" |<nowiki>+</nowiki>
| align="center" |<nowiki>+/-</nowiki>
| align="center" |Lower extremity
| align="center" |↑↑
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" |↑
| align="center" | -
| align="center" |↑
| align="center" | +
|[[Hyperkeratosis]], [[edema]], and [[erythema]]
|[[Sclerodactyly]], [[Telangiectasias]], [[Calcinosis]], [[Malignant hypertension]], [[acute renal failure]]
|-
| colspan="2" align="center" style="background:#DCDCDC;" |[[Sjögren’s syndrome]]<ref name="pmid15485020">{{cite journal |vauthors=Roguedas AM, Misery L, Sassolas B, Le Masson G, Pennec YL, Youinou P |title=Cutaneous manifestations of primary Sjögren's syndrome are underestimated |journal=Clin. Exp. Rheumatol. |volume=22 |issue=5 |pages=632–6 |year=2004 |pmid=15485020 |doi= |url=}}</ref>
| align="center" |<nowiki>+/-</nowiki>
| align="center" |<nowiki>+/-</nowiki>
| align="center" | -
| align="center" | -
| align="center" |[[Lower extremity]], axiallary creases
| align="center" |↑
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" |↑
| align="center" |↑
| align="center" | -
| align="center" | -
|[[Xerosis]], scaly skin, annular [[erythema]]
|[[Keratoconjunctivitis sicca]]
|-
| rowspan="3" align="center" style="background:#DCDCDC;" |Vasculitis
| align="center" style="background:#DCDCDC;" |[[Giant cell]]<ref name="pmid17031245">{{cite journal |vauthors=Bablekos GD, Michaelides SA, Karachalios GN, Nicolaou IN, Batistatou AK, Charalabopoulos KA |title=Pericardial involvement as an atypical manifestation of giant cell arteritis: report of a clinical case and literature review |journal=Am. J. Med. Sci. |volume=332 |issue=4 |pages=198–204 |year=2006 |pmid=17031245 |doi= |url=}}</ref>
| align="center" | -
| align="center" |<nowiki>+</nowiki>
| align="center" |<nowiki>+</nowiki>
| align="center" | -
| align="center" |Distal extremity
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| rowspan="3" align="center" | -
|Rare
|Involvement of cranial branches of arteries, visual loss
|-
| align="center" style="background:#DCDCDC;" |[[Takayasu's arteritis|Takayasu]]<ref name="pmid12655">{{cite journal |vauthors=Lupi-Herrera E, Sánchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela JE |title=Takayasu's arteritis. Clinical study of 107 cases |journal=Am. Heart J. |volume=93 |issue=1 |pages=94–103 |year=1977 |pmid=12655 |doi= |url=}}</ref>
| align="center" |<nowiki>-</nowiki>
| align="center" | +/-
| align="center" | +/-
| align="center" | -
| align="center" |Transient extremity
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
|[[Erythema nodosum]], [[pyoderma gangrenosum]]
|Absent or weak peripheral pulse
|-
| align="center" style="background:#DCDCDC;" |[[Polyarteritis nodosa|Poly-arteritis nodosa]]<ref name="pmid20112401">{{cite journal |vauthors=Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, Bienvenu B, Mouthon L, Guillevin L |title=Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database |journal=Arthritis Rheum. |volume=62 |issue=2 |pages=616–26 |year=2010 |pmid=20112401 |doi=10.1002/art.27240 |url=}}</ref>
| align="center" | -
| align="center" | +/-
| align="center" | -
| align="center" | -
| align="center" |General and mild
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
|[[Tenderness|Tender]] [[Erythematous rash|erythematous nodules]], [[purpura]], [[livedo reticularis]], [[bullous]] or [[Vesicular|vesicular eruption]]
|[[Testicular pain]] or [[tenderness]] and [[neuropathies]]
|-
| colspan="2" align="center" style="background:#DCDCDC;" |[[Behçet's Syndrome|Behçet’s syndrome]]<ref name="pmid11760398">{{cite journal |vauthors=Tunç R, Uluhan A, Melikoğlu M, Ozyazgan Y, Ozdoğan H, Yazici H |title=A reassessment of the International Study Group criteria for the diagnosis (classification) of Behçet's syndrome |journal=Clin. Exp. Rheumatol. |volume=19 |issue=5 Suppl 24 |pages=S45–7 |year=2001 |pmid=11760398 |doi= |url=}}</ref>
| align="center" |<nowiki>+/-</nowiki>
| align="center" |<nowiki>+/-</nowiki>
| align="center" |<nowiki>+/-</nowiki>
| align="center" | -
| align="center" |medium and large joints
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
|Recurrent and usually painful [[mucocutaneous]] ulcers, [[Acneiform eruption|acneiform]] [[lesions]], papulo-vesiculo-[[Pustular rash|pustular]] eruptions, superficial [[thrombophlebitis]]
|Male dominancy
|-
| colspan="2" align="center" style="background:#DCDCDC;" |[[Serum sickness]]<ref name="pmid3564980">{{cite journal |vauthors=Kunnamo I, Kallio P, Pelkonen P, Viander M |title=Serum-sickness-like disease is a common cause of acute arthritis in children |journal=Acta Paediatr Scand |volume=75 |issue=6 |pages=964–9 |year=1986 |pmid=3564980 |doi= |url=}}</ref>
| align="center" | +
| align="center" |<nowiki>+</nowiki>
| align="center" |<nowiki>+/-</nowiki>
| align="center" | -
| align="center" |General
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
|[[Pruritic disorders|Pruritic rash]], [[urticaria]] and/or serpiginous [[Rash|macular rash]]
|Self-limited
|-
| colspan="2" align="center" style="background:#DCDCDC;" |[[Psoriatic arthritis]]<ref name="pmid8076388">{{cite journal |vauthors=Oriente P, Biondi-Oriente C, Scarpa R |title=Psoriatic arthritis. Clinical manifestations |journal=Baillieres Clin Rheumatol |volume=8 |issue=2 |pages=277–94 |year=1994 |pmid=8076388 |doi= |url=}}</ref>
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" |Small and large joints
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
|[[Psoriasis]] and [[onychodystrophy]]
|[[Dactylitis]] (sausage digits)
|-
| colspan="2" align="center" style="background:#DCDCDC;" |[[Parvovirus B19|Human parvovirus B19 infection]]<ref name="pmid17384979">{{cite journal |vauthors=Kaufmann J, Buccola JM, Stead W, Rowley C, Wong M, Bates CK |title=Secondary symptomatic parvovirus B19 infection in a healthy adult |journal=J Gen Intern Med |volume=22 |issue=6 |pages=877–8 |year=2007 |pmid=17384979 |pmc=2219874 |doi=10.1007/s11606-007-0173-9 |url=}}</ref>
| align="center" |<nowiki>+</nowiki>
| align="center" |<nowiki>+</nowiki>
| align="center" | -
| align="center" | -
| align="center" |Small joints
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
| align="center" | -
|[[Erythematous rash|Erythematous rashes]]
|Rare in adults, [[Fifth disease|fifth's disease]] in children
|}
</small>
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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{{WS}}
{{WS}}
[[Category:Rare diseases]]
[[Category:Rare diseases]]
[[Category:Infectious disease]]
 
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Latest revision as of 18:07, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

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Differentiating Kikuchi disease from other Diseases

Kikuchi disease is a rare, self-limiting disorder that typically affects the cervical lymph nodes. Recognition of this condition is crucial, especially because it can easily be mistaken for:

Awareness of this disorder will help prevent misdiagnosis and inappropriate treatment.[1]

Differentiating Kikuchi disease from other diseases that may cause arthritis and rash

Abbreviations: ANA: Antinuclear antibody, RF: Rheumatoid factor, Anti-CCp: Anti-cyclic citrullinated protein antibody, Anti U1RNP: Anti-U1 ribonucleoprotein antibodies , Anti Sm : Anti-Sm antibodies, Anti Ro: Anti Ro antibody also called anti-Sjögren's-syndrome-related antigen A antibody, Anti-dsDNA: Anti-double stranded DNA.

Disease Arthritis Auto-antibodies Raynaud phenomenon Rash pattern Distinguishing/specific features
Polyarthritis Tenderness Edema Deformity /Erosion Pattern ANA RF Anti-CCp Anti U1RNP Anti Sm Anti Ro Anti-dsDNA
Kikuchi’s disease[2] - +/- - - medium and large joints ↑/↓ - - - - - - - Transient skin rashes, malar rash, erythematous macules, patches, papules, or plaques May be associated with SLE
Systemic lupus erythematosus[3] + + + - Small joints - - - - + Malar rash and photosensitivity
Rheumatoid arthritis (RA)[4] + + + + Small and large joints - ↑↑ ↑↑ - - - - + Subcutaneous nodules Erosive arthropathy
Rhupus[5] + + + + Small and large joints - + Malar rash and photosensitivity Erosive arthropathy
Mixed connective tissue disease (MCTD)[6] - - - + Small and large joints - ↑↑ - - - - + Cutaneous eruptions, gottron’s papules, photodistributed erythema, poikiloderma, and calcinosis cutis Overlapping features of SLE, systemic sclerosis (SSc), and polymyositis (PM) that lead to more than one diagnosis
Undifferentiated connective tissue disease (UCTD)[7] + - - - Lower extremity - - - - + Erythematous macules, patches, or papules with delicate scale Multiple connective tissue diseases with no enough criteria for a single diagnosis
Systemic sclerosis (SSc)[8] +/- + + +/- Lower extremity ↑↑ - - - - + Hyperkeratosis, edema, and erythema Sclerodactyly, Telangiectasias, Calcinosis, Malignant hypertension, acute renal failure
Sjögren’s syndrome[9] +/- +/- - - Lower extremity, axiallary creases - - - - - Xerosis, scaly skin, annular erythema Keratoconjunctivitis sicca
Vasculitis Giant cell[10] - + + - Distal extremity - - - - - - - - Rare Involvement of cranial branches of arteries, visual loss
Takayasu[11] - +/- +/- - Transient extremity - - - - - - - Erythema nodosum, pyoderma gangrenosum Absent or weak peripheral pulse
Poly-arteritis nodosa[12] - +/- - - General and mild - - - - - - - Tender erythematous nodules, purpura, livedo reticularis, bullous or vesicular eruption Testicular pain or tenderness and neuropathies
Behçet’s syndrome[13] +/- +/- +/- - medium and large joints - - - - - - - - Recurrent and usually painful mucocutaneous ulcers, acneiform lesions, papulo-vesiculo-pustular eruptions, superficial thrombophlebitis Male dominancy
Serum sickness[14] + + +/- - General - - - - - - - - Pruritic rash, urticaria and/or serpiginous macular rash Self-limited
Psoriatic arthritis[15] - - - - Small and large joints - - - - - - - - Psoriasis and onychodystrophy Dactylitis (sausage digits)
Human parvovirus B19 infection[16] + + - - Small joints - - - - - - - - Erythematous rashes Rare in adults, fifth's disease in children

References

  1. Rammohan A, Cherukuri SD, Manimaran AB, Manohar RR, Naidu RM (2012). "Kikuchi-Fujimoto Disease: A Sheep in Wolf's Clothing". J Otolaryngol Head Neck Surg. 41 (3): 222–226. PMID 22762705. Unknown parameter |month= ignored (help)
  2. Kucukardali Y, Solmazgul E, Kunter E, Oncul O, Yildirim S, Kaplan M (2007). "Kikuchi-Fujimoto Disease: analysis of 244 cases". Clin. Rheumatol. 26 (1): 50–4. doi:10.1007/s10067-006-0230-5. PMID 16538388.
  3. Ehmke TA, Cherian JJ, Wu ES, Jauregui JJ, Banerjee S, Mont MA (2014). "Treatment of osteonecrosis in systemic lupus erythematosus: a review". Curr Rheumatol Rep. 16 (9): 441. doi:10.1007/s11926-014-0441-8. PMID 25074031.
  4. Lee DM, Weinblatt ME (2001). "Rheumatoid arthritis". Lancet. 358 (9285): 903–11. doi:10.1016/S0140-6736(01)06075-5. PMID 11567728.
  5. Panush RS, Edwards NL, Longley S, Webster E (1988). "'Rhupus' syndrome". Arch. Intern. Med. 148 (7): 1633–6. PMID 3382309.
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