Differentiating systemic lupus erythematosus from other diseases: Difference between revisions

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Revision as of 20:07, 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	+							+	Malar rash and photosensitivity
Rheumatoid arthritis (RA)		+	+	+	+	Small and large joints		↑↑	↑↑					+	Subcutaneous nodules
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, axiallary creases	↑					↑			xerosis, scaly skin, annular erythema	Keratoconjunctivitis sicca, Xerostomia
Vasculitis	Giant cell		+	+		Distal extremity									Rare	Involvement of cranial branches of arteries, visual loss
	Takayasu		+/-	+/-		Transient extremity									Erythema nodosum, pyoderma gangrenosum	Absent or weak peripheral pulse
	Poly-arteritis nodosa		+/-			General and mild									Tender erythematous nodules, purpura, livedo reticularis, bullous or vesicular eruption	Testicular pain or tenderness and neuropathies
Behçet’s syndrome		+/-	+/-	+/-		medium and large joints									Recurrent and usually painful mucocutaneous ulcers, acneiform lesions, papulo-vesiculo-pustular eruptions, superficial thrombophlebitis	Male dominancy
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	Self-limited
Psoriatic arthritis						Small and large joints									Psoriasis and onychodystrophy	dactylitis (“sausage digits”)
Human parvovirus B19 infection		+	+			Small joints										Flu-like symptoms with 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 33: / Line 33: @@
 |-
 | colspan="2" align="center" style="background:#DCDCDC;" |[[Systemic lupus erythematosus]]
-|
+|<nowiki>+</nowiki>
-|
+|<nowiki>+</nowiki>
-|
+|<nowiki>+</nowiki>
 |
 |Small joints
+|<nowiki>+</nowiki>
 |
 |
@@ Line 44: / Line 45: @@
 |
 |
-|
+|<nowiki>+</nowiki>
-|
+|Malar rash and photosensitivity
-|
 |
 |-
@@ Line 63: / Line 63: @@
 |
 | +
-|
+|Subcutaneous nodules
 |
 *
@@ Line 144: / Line 144: @@
 |
 |
-|Lower extremity
+|Lower extremity, axiallary creases
-and
-axiallary creases
 |↑
 |
@@ Line 166: / Line 163: @@
 |<nowiki>+</nowiki>
 |
-|
+|Distal extremity
 |
 |
@@ Line 176: / Line 173: @@
 | rowspan="3" |
 |Rare
-|Involvement of ranial branches of arteries, visual loss
+|Involvement of cranial branches of arteries, visual loss
 |-
 | align="center" style="background:#DCDCDC;" |[[Takayasu's arteritis|Takayasu]]
@@ Line 183: / Line 180: @@
 | +/-
 |
+|Transient extremity
 |
 |
@@ Line 190: / Line 188: @@
 |
 |
-|
+|Erythema nodosum, pyoderma gangrenosum
-|
+|Absent or weak peripheral pulse
-* Erythema nodosum
-* Pyoderma gangrenosum
-|
 |-
 | align="center" style="background:#DCDCDC;" |[[Polyarteritis nodosa|Poly-arteritis nodosa]]
@@ Line 201: / Line 196: @@
 |
 |
+|General and mild
 |
 |
@@ Line 208: / Line 204: @@
 |
 |
-|
+|Tender erythematous nodules, purpura, livedo reticularis, bullous or vesicular eruption
-|
+|Testicular pain or tenderness and neuropathies
-* tender erythematous nodules
-* Purpura
-* Livedo reticularis
-* Bullous or vesicular eruption
-|
 |-
 | colspan="2" align="center" style="background:#DCDCDC;" |Behçet’s syndrome
@@ Line 221: / Line 212: @@
 |<nowiki>+/-</nowiki>
 |
+|medium and large joints
 |
 |
@@ Line 229: / Line 221: @@
 |
 |
-|
+|Recurrent and usually painful mucocutaneous ulcers, acneiform lesions, papulo-vesiculo-pustular eruptions, superficial thrombophlebitis
-|
+|Male dominancy
-* acneiform lesions
-* Papulo-vesiculo-pustular eruptions
-* Superficial thrombophlebitis
-|
-* Male dominancy
-* [[ANA]]-negative
 |-
 | colspan="2" align="center" style="background:#DCDCDC;" |Kikuchi’s disease
@@ Line 252: / Line 238: @@
 |
 |
-|
+|Transient skin rashes, malar rash, erythematous macules, patches, papules, or plaques
-* Transient skin rashes
+|May be associated with SLE
-* Malar rash
-* Erythematous macules, patches, papules, or plaques
-|
-* May be associated with SLE
 |-
 | colspan="2" align="center" style="background:#DCDCDC;" |Serum sickness
@@ Line 274: / Line 255: @@
 |
 |
-|
+|Pruritic rash, urticarial and/or serpiginous macular rash
-* pruritic rash
+|Self-limited
-* urticarial and/or serpiginous macular rash
-|
-* Negative [[Antinuclear antibodies|ANA]]
-* Self-limited
 |-
 | colspan="2" align="center" style="background:#DCDCDC;" |Psoriatic arthritis
@@ Line 295: / Line 272: @@
 |
 |
-|
+|Psoriasis and onychodystrophy
-|
+|dactylitis (“sausage digits”)
 |-
 | colspan="2" align="center" style="background:#DCDCDC;" |Human [[parvovirus]] B19 infection
@@ Line 313: / Line 290: @@
 |
 |
-*
+|Flu-like symptoms with hematologic abnormalities such as [[leukopenia]] and [[thrombocytopenia]]
-|
-* Flu-like symptoms
-* Hematologic abnormalities such as [[leukopenia]] and [[thrombocytopenia]]
 |}