Undifferentiated connective tissue disease differential diagnosis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
===== Differentiating SLE 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> | |||
<br> | |||
<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;" |[[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;" |[[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> | |||
| align="center" | - | |||
| align="center" |<nowiki>+/-</nowiki> | |||
| align="center" | - | |||
| align="center" | - | |||
| align="center" |medium and large joints | |||
| align="center" |↑/↓ | |||
| align="center" | - | |||
| align="center" | - | |||
| align="center" | - | |||
| align="center" | - | |||
| align="center" | - | |||
| align="center" | - | |||
| align="center" | - | |||
|Transient skin [[rashes]], [[malar rash]], [[Macule|erythematous macules]], patches, [[papules]], or [[plaques]] | |||
|May be associated with SLE | |||
|- | |||
| 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== |
Revision as of 20:53, 1 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
Differential Diagnosis
Differentiating SLE 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 | |||||
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.
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