Differentiating systemic lupus erythematosus from other diseases: Difference between revisions
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|Erosive [[arthropathy]] | |Erosive [[arthropathy]] | ||
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| colspan="2" align="center" style="background:#DCDCDC;" |Rhupus | | 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> | ||
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|Overlapping features of SLE, [[systemic sclerosis]] (SSc), and [[polymyositis]] (PM) that lead to more than one diagnosis | |Overlapping features of SLE, [[systemic sclerosis]] (SSc), and [[polymyositis]] (PM) that lead to more than one diagnosis | ||
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| colspan="2" align="center" style="background:#DCDCDC;" |[[Undifferentiated connective tissue disease]] (UCTD) | | 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> | ||
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|Multiple connective tissue diseases with no enough criteria for a single diagnosis | |Multiple connective tissue diseases with no enough criteria for a single diagnosis | ||
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| colspan="2" align="center" style="background:#DCDCDC;" |[[Systemic sclerosis]] (SSc) | | 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> | ||
|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
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| rowspan="3" align="center" style="background:#DCDCDC;" |Vasculitis | | rowspan="3" align="center" style="background:#DCDCDC;" |Vasculitis | ||
| align="center" style="background:#DCDCDC;" |[[Giant cell]] | | 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> | ||
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|Involvement of cranial branches of arteries, visual loss | |Involvement of cranial branches of arteries, visual loss | ||
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| align="center" style="background:#DCDCDC;" |[[Takayasu's arteritis|Takayasu]] | | 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> | ||
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|Absent or weak peripheral pulse | |Absent or weak peripheral pulse | ||
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| align="center" style="background:#DCDCDC;" |[[Polyarteritis nodosa|Poly-arteritis nodosa]] | | 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> | ||
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| +/- | | +/- | ||
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|[[Testicular pain]] or [[tenderness]] and [[neuropathies]] | |[[Testicular pain]] or [[tenderness]] and [[neuropathies]] | ||
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| colspan="2" align="center" style="background:#DCDCDC;" |[[Behçet's Syndrome|Behçet’s syndrome]] | | 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> | ||
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|May be associated with SLE | |May be associated with SLE | ||
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| colspan="2" align="center" style="background:#DCDCDC;" |[[Serum sickness]] | | 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> | ||
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|Self-limited | |Self-limited | ||
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| colspan="2" align="center" style="background:#DCDCDC;" |[[Psoriatic arthritis]] | | 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> | ||
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|[[Dactylitis]] (“sausage digits”) | |[[Dactylitis]] (“sausage digits”) | ||
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| colspan="2" align="center" style="background:#DCDCDC;" | | | 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> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
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Revision as of 21:33, 25 July 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]
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 | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Polyarthritis | Tenderness | Edema | Deformity /Erosion | Pattern | ANA | RF | Anti-CCp | anti U1RNP | AntiSm | AntiRo | Anti-dsDNA | |||||
| Systemic lupus erythematosus[1] | + | + | + | - | Small joints | ↑ | - | - | - | ↑ | ↑ | - | + | Malar rash and photosensitivity | ||
| Rheumatoid arthritis (RA)[2] | + | + | + | + | Small and large joints | - | ↑↑ | ↑↑ | - | - | - | - | + | Subcutaneous nodules | Erosive arthropathy | |
| Rhupus[3] | + | + | + | + | Small and large joints | ↑ | ↑ | ↑ | ↑ | ↑ | - | ↑ | + | Malar rash and photosensitivity | Erosive arthropathy | |
| Mixed connective tissue disease (MCTD)[4] | - | - | - | + | 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)[5] | + | - | - | - | 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)[6] | +/- | + | + | +/- | Lower extremity | ↑↑ | - | - | - | ↑ | - | ↑ | + | Hyperkeratosis, edema, and erythema | Sclerodactyly, Telangiectasias, Calcinosis, Malignant hypertension, acute renal failure | |
| Sjögren’s syndrome[7] | +/- | +/- | - | - | Lower extremity, axiallary creases | ↑ | - | - | - | ↑ | ↑ | - | - | Xerosis, scaly skin, annular erythema | Keratoconjunctivitis sicca | |
| Vasculitis | Giant cell[8] | - | + | + | - | Distal extremity | - | - | - | - | - | - | - | - | Rare | Involvement of cranial branches of arteries, visual loss |
| Takayasu[9] | - | +/- | +/- | - | Transient extremity | - | - | - | - | - | - | - | Erythema nodosum, pyoderma gangrenosum | Absent or weak peripheral pulse | ||
| Poly-arteritis nodosa[10] | - | +/- | - | - | General and mild | - | - | - | - | - | - | - | Tender erythematous nodules, purpura, livedo reticularis, bullous or vesicular eruption | Testicular pain or tenderness and neuropathies | ||
| Behçet’s syndrome[11] | +/- | +/- | +/- | - | medium and large joints | - | - | - | - | - | - | - | - | Recurrent and usually painful mucocutaneous ulcers, acneiform lesions, papulo-vesiculo-pustular eruptions, superficial thrombophlebitis | Male dominancy | |
| Kikuchi’s disease[12] | - | +/- | - | - | medium and large joints | ↑/↓ | - | - | - | - | - | - | - | Transient skin rashes, malar rash, erythematous macules, patches, papules, or plaques | May be associated with SLE | |
| Serum sickness[13] | + | + | +/- | - | General | - | - | - | - | - | - | - | - | Pruritic rash, urticaria and/or serpiginous macular rash | Self-limited | |
| Psoriatic arthritis[14] | - | - | - | - | Small and large joints | - | - | - | - | - | - | - | - | Psoriasis and onychodystrophy | Dactylitis (“sausage digits”) | |
| Human parvovirus B19 infection[15] | + | + | - | - | Small joints | - | - | - | - | - | - | - | - | Erythematous rashes | Rare in adults, fifth's disease in children | |
References
- ↑ 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.
- ↑ Lee DM, Weinblatt ME (2001). "Rheumatoid arthritis". Lancet. 358 (9285): 903–11. doi:10.1016/S0140-6736(01)06075-5. PMID 11567728.
- ↑ Panush RS, Edwards NL, Longley S, Webster E (1988). "'Rhupus' syndrome". Arch. Intern. Med. 148 (7): 1633–6. PMID 3382309.
- ↑ 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.
- ↑ Alarcón GS, Williams GV, Singer JZ, Steen VD, Clegg DO, Paulus HE, Billingsley LM, Luggen ME, Polisson RP, Willkens RF (1991). "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". J. Rheumatol. 18 (9): 1332–9. PMID 1757934.
- ↑ LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA, Rowell N, Wollheim F (1988). "Scleroderma (systemic sclerosis): classification, subsets and pathogenesis". J. Rheumatol. 15 (2): 202–5. PMID 3361530.
- ↑ Roguedas AM, Misery L, Sassolas B, Le Masson G, Pennec YL, Youinou P (2004). "Cutaneous manifestations of primary Sjögren's syndrome are underestimated". Clin. Exp. Rheumatol. 22 (5): 632–6. PMID 15485020.
- ↑ Bablekos GD, Michaelides SA, Karachalios GN, Nicolaou IN, Batistatou AK, Charalabopoulos KA (2006). "Pericardial involvement as an atypical manifestation of giant cell arteritis: report of a clinical case and literature review". Am. J. Med. Sci. 332 (4): 198–204. PMID 17031245.
- ↑ Lupi-Herrera E, Sánchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela JE (1977). "Takayasu's arteritis. Clinical study of 107 cases". Am. Heart J. 93 (1): 94–103. PMID 12655.
- ↑ Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, Bienvenu B, Mouthon L, Guillevin L (2010). "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". Arthritis Rheum. 62 (2): 616–26. doi:10.1002/art.27240. PMID 20112401.
- ↑ Tunç R, Uluhan A, Melikoğlu M, Ozyazgan Y, Ozdoğan H, Yazici H (2001). "A reassessment of the International Study Group criteria for the diagnosis (classification) of Behçet's syndrome". Clin. Exp. Rheumatol. 19 (5 Suppl 24): S45–7. PMID 11760398.
- ↑ 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.
- ↑ Kunnamo I, Kallio P, Pelkonen P, Viander M (1986). "Serum-sickness-like disease is a common cause of acute arthritis in children". Acta Paediatr Scand. 75 (6): 964–9. PMID 3564980.
- ↑ Oriente P, Biondi-Oriente C, Scarpa R (1994). "Psoriatic arthritis. Clinical manifestations". Baillieres Clin Rheumatol. 8 (2): 277–94. PMID 8076388.
- ↑ Kaufmann J, Buccola JM, Stead W, Rowley C, Wong M, Bates CK (2007). "Secondary symptomatic parvovirus B19 infection in a healthy adult". J Gen Intern Med. 22 (6): 877–8. doi:10.1007/s11606-007-0173-9. PMC 2219874. PMID 17384979.