Differentiating systemic lupus erythematosus from other diseases: Difference between revisions

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Revision as of 19:34, 11 July 2017

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							Raynaud phenamon	Rash pattern	Distinguishing/specific features
n		Polyarthritis	Tenderness	Edema	Deformity /Erosion	Pattern	ANA	RF	Anti-CCp	anti U1RNP	AntiSm	AntiRo	Anti-dsDNA	Raynaud phenamon	Rash pattern	Distinguishing/specific features
Systemic lupus erythematosus						Small joints
Rheumatoid arthritis (RA)		+	+	+	+	Small and large joints		↑↑	↑↑					+
Rhupus		+	+	+	+	Small and large joints	↑	↑	↑	↑	↑		↑	+		Erosive arthropathy
Mixed connective tissue disease (MCTD)^[1]					+	Small and large joints		↑↑	↑					+		Overlapping features of SLE, systemic sclerosis (SSc), and polymyositis (PM)
Undifferentiated connective tissue disease (UCTD)		+				Lower extremity	↑	↑			↑			+	erythematous macules, patches, or papules with delicate scale mostly in lower extremities
Systemic sclerosis (SSc)		+/-	+	+	+/-		↑↑				↑		↑	+	skin thickening and hardening and edematous swelling and erythema	Sclerodactyly, Telangiectasias, Calcinosis, Malignant hypertension, acute renal failure
Sjögren’s syndrome 15485020		+/-	+/-			Lower extremity and axiallary creases	↑					↑			xerosis, scaly skin, annular erythema	Keratoconjunctivitis sicca, Xerostomia
Vasculitis	Giant cell		+	+											Rare	Involvement of ranial branches of arteries, visual loss
	Takayasu		+/-	+/-											Erythema nodosum Pyoderma gangrenosum
	Poly-arteritis nodosa		+/-												tender erythematous nodules Purpura Livedo reticularis Bullous or vesicular eruption
Behçet’s syndrome		+/-	+/-	+/-											acneiform lesions Papulo-vesiculo-pustular eruptions Superficial thrombophlebitis	Male dominancy ANA-negative
Kikuchi’s disease			+/-				↑/↓								Transient skin rashes Malar rash Erythematous macules, patches, papules, or plaques	May be associated with SLE
Serum sickness		+/-	+	+/-											pruritic rash urticarial and/or serpiginous macular rash	Negative ANA Self-limited
Psoriatic arthritis						Small and large joints
Human parvovirus B19 infection		+	+			Small joints										Flu-like symptoms Hematologic abnormalities such as leukopenia and thrombocytopenia

References

↑ 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.

[pmid21959290-1] 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.

[1]

@@ Line 32: / Line 32: @@
 ! align="center" style="background:#4479BA; color: #FFFFFF;" |Anti-dsDNA
 |-
-| colspan="2"  align="center" style="background:#DCDCDC;" |[[Systemic lupus erythematosus]]
+| colspan="2" align="center" style="background:#DCDCDC;" |[[Systemic lupus erythematosus]]
 |
 |
@@ Line 49: / Line 49: @@
 |
 |-
-| colspan="2"  align="center" style="background:#DCDCDC;" |[[Rheumatoid arthritis]] ([[Rheumatoid arthritis|RA]])
+| colspan="2" align="center" style="background:#DCDCDC;" |[[Rheumatoid arthritis]] ([[Rheumatoid arthritis|RA]])
 | +
 | +
@@ Line 64: / Line 64: @@
 | +
 |
-*
 |
 *
 |-
-| colspan="2"  align="center" style="background:#DCDCDC;" |Rhupus
+| colspan="2" align="center" style="background:#DCDCDC;" |Rhupus
 | +
 | +
@@ Line 83: / Line 82: @@
 | +
 |
-* Patients with overlapping features of both SLE and [[Rheumatoid arthritis|RA]]
+|Erosive [[arthropathy]]
-* Serologies consistent with both SLE and [[Rheumatoid arthritis|RA]]
-|
-* Erosive [[arthropathy]] that is atypical for SLE
 |-
-| 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>
+| 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>
 |
 |
@@ Line 103: / Line 99: @@
 | +
 |
-* A mix disease with overlapping features of SLE, [[systemic sclerosis]] (SSc), and [[polymyositis]] (PM)
+|Overlapping features of SLE, [[systemic sclerosis]] (SSc), and [[polymyositis]] (PM)
-* [[Antibodies]] against U1 ribonucleoprotein (RNP)
-|
-*
 |-
-| colspan="2"  align="center" style="background:#DCDCDC;" |[[Undifferentiated connective tissue disease]] (UCTD)
+| colspan="2" align="center" style="background:#DCDCDC;" |[[Undifferentiated connective tissue disease]] (UCTD)
 | +
 |
 |
 |
-|Small and large joints
+|Lower extremity
 |↑
 |↑
@@ Line 122: / Line 115: @@
 |
 | +
+|erythematous macules, patches, or papules with delicate scale
+mostly in lower extremities
 |
-* erythematous macules, patches, or papules with delicate scale
+*
-* mostly in lower extremities
-|
-* sclerodactyly
-* telangiectasias
-* calcinosis
-* malignant hypertension
-* acute renal failure
 |-
-| colspan="2"  align="center" style="background:#DCDCDC;" |[[Systemic sclerosis]] (SSc)
+| colspan="2" align="center" style="background:#DCDCDC;" |[[Systemic sclerosis]] (SSc)
 |<nowiki>+/-</nowiki>
 |<nowiki>+</nowiki>
@@ Line 146: / Line 135: @@
 |↑
 | +
-|
+|skin thickening and hardening and edematous swelling and erythema
-* skin thickening and hardening
+|[[Sclerodactyly]], [[Telangiectasias]], [[Calcinosis]], [[Malignant hypertension]], [[acute renal failure]]
-* Edematous swelling and erythema
-|
-* [[Sclerodactyly]]
-* [[Telangiectasias]]
-* [[Calcinosis]]
-* [[Malignant hypertension]]
-* [[acute renal failure]]
 |-
-| colspan="2"  align="center" style="background:#DCDCDC;" |Sjögren’s syndrome
+| colspan="2" align="center" style="background:#DCDCDC;" |Sjögren’s syndrome
 15485020
 |<nowiki>+/-</nowiki>
@@ Line 174: / Line 156: @@
 |
 |
-|
+|xerosis, scaly skin, annular erythema
-* Xerosis
-* Scaly skin
-* Annular erythema
-|
+|[[Keratoconjunctivitis sicca]], [[Xerostomia]]
-* [[Keratoconjunctivitis sicca]]
-* [[Xerostomia]]
 |-
-| rowspan="3"  align="center" style="background:#DCDCDC;" |Vasculitis
+| rowspan="3" align="center" style="background:#DCDCDC;" |Vasculitis
 | align="center" style="background:#DCDCDC;" |Giant cell
 |
@@ Line 197: / Line 174: @@
 |
 |
-| rowspan="3"|
+| rowspan="3" |
-|
+|Rare
-* Rare
+|Involvement of ranial branches of arteries, visual loss
-|
-* cranial branches of arteries
-* visual loss
 |-
 | align="center" style="background:#DCDCDC;" |[[Takayasu's arteritis|Takayasu]]
@@ Line 242: / Line 216: @@
 |
 |-
-| colspan="2"  align="center" style="background:#DCDCDC;" |Behçet’s syndrome
+| colspan="2" align="center" style="background:#DCDCDC;" |Behçet’s syndrome
 |<nowiki>+/-</nowiki>
 |<nowiki>+/-</nowiki>
@@ Line 264: / Line 238: @@
 * [[ANA]]-negative
 |-
-| colspan="2"  align="center" style="background:#DCDCDC;" |Kikuchi’s disease
+| colspan="2" align="center" style="background:#DCDCDC;" |Kikuchi’s disease
 |
 |<nowiki>+/-</nowiki>
@@ Line 286: / Line 260: @@
 * May be associated with SLE
 |-
-| colspan="2"  align="center" style="background:#DCDCDC;" |Serum sickness
+| colspan="2" align="center" style="background:#DCDCDC;" |Serum sickness
 |<nowiki>+/-</nowiki>
 |<nowiki>+</nowiki>
@@ Line 307: / Line 281: @@
 * Self-limited
 |-
-| colspan="2"  align="center" style="background:#DCDCDC;" |Psoriatic arthritis
+| colspan="2" align="center" style="background:#DCDCDC;" |Psoriatic arthritis
 |
 |
@@ Line 324: / Line 298: @@
 |
 |-
-| colspan="2"  align="center" style="background:#DCDCDC;" |Human [[parvovirus]] B19 infection
+| colspan="2" align="center" style="background:#DCDCDC;" |Human [[parvovirus]] B19 infection
 |<nowiki>+</nowiki>
 |<nowiki>+</nowiki>