Differentiating systemic lupus erythematosus from other diseases: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Skazmi (talk | contribs)
CMEAdmin, CMEUser, Bureaucrats, nocaptcha, smwadministrator, Administrators, Widget editors
6,688 edits
No edit summary
Mmir (talk | contribs)
CMEAdmin, CMEUser, Bureaucrats, bureaucrats, nocaptcha, smwadministrator, Administrators, Widget editors
14,850 edits
Line 10: Line 10:
Systemic lupus erythematosus (SLE) must be differentiated from other diseases that cause skin rash, [[arthritis]], positive [[autoimmune]] serology, weight loss, [[Fever|fevers]] and [[chronic pain]], such as [[rheumatoid arthritis]](RA), [[mixed connective tissue disease]] (MCTD), [[systemic sclerosis]] (SSc), [[dermatomyositis]] (DM), [[polymyositis]](PM), and other autoimmune diseases.  
Systemic lupus erythematosus (SLE) must be differentiated from other diseases that cause skin rash, [[arthritis]], positive [[autoimmune]] serology, weight loss, [[Fever|fevers]] and [[chronic pain]], such as [[rheumatoid arthritis]](RA), [[mixed connective tissue disease]] (MCTD), [[systemic sclerosis]] (SSc), [[dermatomyositis]] (DM), [[polymyositis]](PM), and other autoimmune diseases.  


===== Differetiating SLE from other diseases that cause [[arthritis]], positive [[autoimmune]] serology, and [[Constitutional acrocyanosis|constitutional]] symptoms =====
===== Differetiating SLE from other diseases that cause [[arthritis]] and [[rash]] =====
{| class="wikitable"
{| class="wikitable"
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" |n
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Overlapping Features
! colspan="5" |Arthritis
! colspan="6" |Auto-antibodies
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Rash pattern
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Distinguishing/specific features
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Distinguishing/specific features
|-
!
!
!Polyarthritis
!Monoarthiritis
!Tenderness
!Swelling
!Deformity /Erosion
!ANA
!RF
!Anti-CCp
!anti U1RNP
!AntiSm
!Anti Ro
!
!
|-
|-
| colspan="2" |[[Rheumatoid arthritis]] ([[Rheumatoid arthritis|RA]])
| colspan="2" |[[Rheumatoid arthritis]] ([[Rheumatoid arthritis|RA]])
| +
|
| +
| +
| +
|
|↑↑
|↑↑
|
|
|
|
|
* [[Serositis]]
* [[Serositis]]
Line 32: Line 61:
|-
|-
| colspan="2" |Rhupus
| colspan="2" |Rhupus
| +
|
| +
| +
| +
|↑
|↑
|↑
|↑
|↑
|↑
|
|
* Patients with overlapping features of both SLE and [[Rheumatoid arthritis|RA]]
* Patients with overlapping features of both SLE and [[Rheumatoid arthritis|RA]]
Line 39: Line 79:
|-
|-
| colspan="2" |[[Mixed connective tissue disease]] (MCTD)
| colspan="2" |[[Mixed connective tissue disease]] (MCTD)
|
|
|
|
| +
|
|↑↑
|↑
|
|
|
|
|
* A mix disease with overlapping features of SLE, [[systemic sclerosis]] (SSc), and [[polymyositis]] (PM)
* A mix disease with overlapping features of SLE, [[systemic sclerosis]] (SSc), and [[polymyositis]] (PM)
Line 47: Line 98:
|-
|-
| colspan="2" |[[Undifferentiated connective tissue disease]] (UCTD)
| colspan="2" |[[Undifferentiated connective tissue disease]] (UCTD)
| +
|
|
|
|
|
|
|
|
|
|
|
|
* [[Arthritis]] and [[Arthralgia|arthralgias]]
* erythematous macules, patches, or papules with delicate scale
* [[Raynaud phenomenon]]
* mostly in lower extremities
* Serological findings
|
|
* Mild disease course
* sclerodactyly
* telangiectasias
* calcinosis
* malignant hypertension
* acute renal failure
|-
|-
| colspan="2" |[[Systemic sclerosis]] (SSc)
| colspan="2" |[[Systemic sclerosis]] (SSc)
|
|
|
|
|
|
|
|
|
|
|
|
|
* Positive [[ANA]]
* Positive [[ANA]]
Line 68: Line 144:
|-
|-
| colspan="2" |Sjögren’s syndrome
| colspan="2" |Sjögren’s syndrome
|
|
|
|
|
|
|
|
|
|
|
|
|
* Extra-glandular manifestations
* Extra-glandular manifestations
Line 80: Line 167:
|-
|-
| colspan="2" |Vasculitis
| colspan="2" |Vasculitis
|
|
|
|
|
|
|
|
|
|
|
|
|
* Medium and small vessel [[vasculitides]]:
* Medium and small vessel [[vasculitides]]:
Line 93: Line 191:
|-
|-
| colspan="2" |Behçet’s syndrome
| colspan="2" |Behçet’s syndrome
|
|
|
|
|
|
|
|
|
|
|
|
|
* Oral aphthae
* Oral aphthae
Line 104: Line 213:
|-
|-
| colspan="2" |Dermatomyositis (DM) and polymyositis (PM)
| colspan="2" |Dermatomyositis (DM) and polymyositis (PM)
|
|
|
|
|
|
|
|
|
|
|
|
|
* Positive [[ANA]]: In approximately 30 percent of patients
* Positive [[ANA]]: In approximately 30 percent of patients
Line 113: Line 233:
|-
|-
| colspan="2" |Adult Still’s disease (ASD)
| colspan="2" |Adult Still’s disease (ASD)
|
|
|
|
|
|
|
|
|
|
|
|
|
* [[Fever]]
* [[Fever]]
Line 122: Line 253:
|-
|-
| colspan="2" |Kikuchi’s disease
| colspan="2" |Kikuchi’s disease
|
|
|
|
|
|
|
|
|
|
|
|
|
* [[Lymphadenopathy]]
* [[Lymphadenopathy]]
Line 134: Line 276:
|-
|-
| colspan="2" |Serum sickness
| colspan="2" |Serum sickness
|
|
|
|
|
|
|
|
|
|
|
|
|
* [[Fever]]
* [[Fever]]
Line 145: Line 298:
|-
|-
| colspan="2" |Fibromyalgia
| colspan="2" |Fibromyalgia
|
|
|
|
|
|
|
|
|
|
|
|
|
* [[Arthralgias]]
* [[Arthralgias]]
Line 154: Line 318:
| rowspan="9" |Infections
| rowspan="9" |Infections
| rowspan="7" |Viruses
| rowspan="7" |Viruses
|
|
|
|
|
|
|
|
|
|
|
|
|
* Human [[parvovirus]] B19:
* Human [[parvovirus]] B19:
Line 162: Line 337:
* Serologic assays can be diagnostic for many of these viruses
* Serologic assays can be diagnostic for many of these viruses
|-
|-
|
|
|
|
|
|
|
|
|
|
|
|
|
* [[Epstein Barr virus|EBV]]
* [[Epstein Barr virus|EBV]]
** May lead to a positive [[ANA]]<ref name="pmid3020161">{{cite journal |vauthors=Sculley DG, Sculley TB, Pope JH |title=Reactions of sera from patients with rheumatoid arthritis, systemic lupus erythematosus and infectious mononucleosis to Epstein-Barr virus-induced polypeptides |journal=J. Gen. Virol. |volume=67 ( Pt 10) |issue= |pages=2253–8 |year=1986 |pmid=3020161 |doi=10.1099/0022-1317-67-10-2253 |url=}}</ref>     
** May lead to a positive [[ANA]]<ref name="pmid3020161">{{cite journal |vauthors=Sculley DG, Sculley TB, Pope JH |title=Reactions of sera from patients with rheumatoid arthritis, systemic lupus erythematosus and infectious mononucleosis to Epstein-Barr virus-induced polypeptides |journal=J. Gen. Virol. |volume=67 ( Pt 10) |issue= |pages=2253–8 |year=1986 |pmid=3020161 |doi=10.1099/0022-1317-67-10-2253 |url=}}</ref>     
|-
|-
|
|
|
|
|
|
|
|
|
|
|
|[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] ([[HIV]])
|[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] ([[HIV]])
|-
|-
|
|
|
|
|
|
|
|
|
|
|
|[[Hepatitis B virus]] ([[HBV]])
|[[Hepatitis B virus]] ([[HBV]])
|-
|-
|
|
|
|
|
|
|
|
|
|
|
|[[Hepatitis C virus]] ([[HCV]])
|[[Hepatitis C virus]] ([[HCV]])
|-
|-
|
|
|
|
|
|
|
|
|
|
|
|[[Cytomegalovirus]] ([[CMV]])
|[[Cytomegalovirus]] ([[CMV]])
|-
|-
|
|
|
|
|
|
|
|
|
|
|
|[[Epstein Barr virus|Epstein-Barr virus]] ([[EBV]])
|[[Epstein Barr virus|Epstein-Barr virus]] ([[EBV]])
|-
|-
| rowspan="2" |Bacterias
| rowspan="2" |Bacterias
|
|
|
|
|
|
|
|
|
|
|
|[[Salmonella]]
|[[Salmonella]]
|-
|-
|
|
|
|
|
|
|
|
|
|
|
|[[Mycobacterium tuberculosis]]
|[[Mycobacterium tuberculosis]]
|-
|-
| colspan="2" |Multiple sclerosis (MS)
| colspan="2" |Multiple sclerosis (MS)
|
|
|
|
|
|
|
|
|
|
|
|
|
* Cranial [[neuropathies]]
* Cranial [[neuropathies]]
Line 190: Line 464:
|-
|-
| colspan="2" |Malignancies
| colspan="2" |Malignancies
|
|
|
|
|
|
|
|
|
|
|
|
|
* [[Leukemia]], [[Myelodysplastic syndrome|myelodysplastic syndromes]], and [[lymphoma]]
* [[Leukemia]], [[Myelodysplastic syndrome|myelodysplastic syndromes]], and [[lymphoma]]
Line 205: Line 490:
|-
|-
| colspan="2" |Thrombotic thrombocytopenic purpura (TTP)
| colspan="2" |Thrombotic thrombocytopenic purpura (TTP)
|
|
|
|
|
|
|
|
|
|
|
|
|
* Fever
* Fever

Revision as of 16:47, 10 July 2017


Systemic lupus erythematosus Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Systemic lupus erythematosus from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Lupus and Quality of Life

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Differentiating systemic lupus erythematosus from other diseases On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Differentiating systemic lupus erythematosus from other diseases

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

National Guidelines Clearinghouse

NICE Guidance

FDA on Differentiating systemic lupus erythematosus from other diseases

on Differentiating systemic lupus erythematosus from other diseases

Differentiating systemic lupus erythematosus from other diseases in the news

Blogs onDifferentiating systemic lupus erythematosus from other diseases

Directions to Hospitals Treating Systemic lupus erythematosus

Risk calculators and risk factors for Differentiating systemic lupus erythematosus from other diseases

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

Overview

Systemic lupus erythematosus (SLE) must be differentiated from other diseases that cause skin rash, arthritis, positive autoimmune serology, weight loss, fevers and chronic pain, such as rheumatoid arthritis(RA), mixed connective tissue disease (MCTD), systemic sclerosis (SSc), dermatomyositis (DM), polymyositis(PM), and other autoimmune diseases.

Differentiating systemic lupus erythematosus from other diseases

Systemic lupus erythematosus (SLE) must be differentiated from other diseases that cause skin rash, arthritis, positive autoimmune serology, weight loss, fevers and chronic pain, such as rheumatoid arthritis(RA), mixed connective tissue disease (MCTD), systemic sclerosis (SSc), dermatomyositis (DM), polymyositis(PM), and other autoimmune diseases.

Differetiating SLE from other diseases that cause arthritis and rash
n Arthritis Auto-antibodies Rash pattern Distinguishing/specific features
Polyarthritis Monoarthiritis Tenderness Swelling Deformity /Erosion ANA RF Anti-CCp anti U1RNP AntiSm Anti Ro
Rheumatoid arthritis (RA) + + + + ↑↑ ↑↑
  • Joint deformities in RA are often more extensive, and frequently erosive on plain radiographs
  • Presence of anti-cyclic citrullinated peptides (CCP)
Rhupus + + + + ↑ ↑ ↑ ↑ ↑ ↑
  • Patients with overlapping features of both SLE and RA
  • Serologies consistent with both SLE and RA
Mixed connective tissue disease (MCTD) + ↑↑ ↑
Undifferentiated connective tissue disease (UCTD) +
  • erythematous macules, patches, or papules with delicate scale
  • mostly in lower extremities
  • sclerodactyly
  • telangiectasias
  • calcinosis
  • malignant hypertension
  • acute renal failure
Systemic sclerosis (SSc)
  • Positive ANA
  • Positive anti-double-stranded DNA (anti-dsDNA)
  • Positive anti-Smith (Sm) antibodies
Sjögren’s syndrome
Vasculitis
Behçet’s syndrome
  • Male dominancy
  • ANA-negative
Dermatomyositis (DM) and polymyositis (PM)
  • More overt proximal muscle weakness than SLE
  • Absence of oral ulcers, arthritis, nephritis, and hematologic abnormalities
  • Myositis-specific antibodies such as anti-Jo-1
Adult Still’s disease (ASD)
Kikuchi’s disease
  • May be associated with SLE
  • Spontaneous remission usually occurring within four months
  • Lymph node biopsy: Histiocytic cellular infiltrate
Serum sickness
  • Negative ANA
  • Self-limited
Fibromyalgia
  • SLE patients may have concomitant fibromyalgia as the prevalence of fibromyalgia in patients with systemic rheumatoid diseases is more
Infections Viruses
  • Serologic assays can be diagnostic for many of these viruses
Human immunodeficiency virus (HIV)
Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Cytomegalovirus (CMV)
Epstein-Barr virus (EBV)
Bacterias Salmonella
Mycobacterium tuberculosis
Multiple sclerosis (MS)
  • Unilateral optic neuritis
  • Pyramidal syndrome
  • Lesions detected by magnetic resonance imaging (MRI) suggesting dissemination in space and time
Malignancies
  • Hematologic abnormalities
  • Constitutional symptoms
Thrombotic thrombocytopenic purpura (TTP)

References

  1. ↑ 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 (2012). ""To be or not to be," ten years after: evidence for mixed connective tissue disease as a distinct entity". Semin. Arthritis Rheum. 41 (4): 589–98. doi:10.1016/j.semarthrit.2011.07.010. PMID 21959290.
  2. ↑ Sculley DG, Sculley TB, Pope JH (1986). "Reactions of sera from patients with rheumatoid arthritis, systemic lupus erythematosus and infectious mononucleosis to Epstein-Barr virus-induced polypeptides". J. Gen. Virol. 67 ( Pt 10): 2253–8. doi:10.1099/0022-1317-67-10-2253. PMID 3020161.
Retrieved from "https://www.wikidoc.org/index.php?title=Differentiating_systemic_lupus_erythematosus_from_other_diseases&oldid=1324745"