Differentiating systemic lupus erythematosus from other diseases: Difference between revisions
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==Overview== | ==Overview== | ||
: Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3]. | |||
: OR | |||
: [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3]. | |||
: OR | |||
: [Disease name] must be differentiated from other causes of [symptom/sign], such as [Differential 1], [Differential 2], and [Differential 3]. | |||
==Differentiating systemic lupus erythematosus from other diseases== | ==Differentiating systemic lupus erythematosus from other diseases== | ||
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| colspan="2" |Rheumatoid arthritis (RA) | | colspan="2" |Rheumatoid arthritis (RA) | ||
| | |joint tenderness and swelling especially in early RA | ||
| | swan neck deformities, ulnar deviation, and soft tissue laxity more common in RA but may seen in SLE as well | ||
serositis, sicca symptoms, subcutaneous nodules, anemia, and fatigue | |||
POsitive ANA: more common in SLE | |||
positive RF: more common in RA | |||
|joint deformities in RA are often more extensive, and frequently erosive on plain radiographs | |||
presence of anti-cyclic citrullinated peptides (CCP) | |||
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|- | |- | ||
| colspan="2" |Rhupus | | colspan="2" |Rhupus | ||
| | |patients with overlapping features of both SLE and RA | ||
serologies consistent with both SLE and RA | |||
erosive arthropathy that is atypical for SLE | |||
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Revision as of 22:26, 17 June 2017
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Differentiating Systemic lupus erythematosus from other Diseases |
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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
- Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
- OR
- [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
- OR
- [Disease name] must be differentiated from other causes of [symptom/sign], such as [Differential 1], [Differential 2], and [Differential 3].
Differentiating systemic lupus erythematosus from other diseases
Overlapping Features | Distinguishing/specific features | |||
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Rheumatoid arthritis (RA) | joint tenderness and swelling especially in early RA
swan neck deformities, ulnar deviation, and soft tissue laxity more common in RA but may seen in SLE as well serositis, sicca symptoms, subcutaneous nodules, anemia, and fatigue POsitive ANA: more common in SLE positive RF: more common in RA |
joint deformities in RA are often more extensive, and frequently erosive on plain radiographs
presence of anti-cyclic citrullinated peptides (CCP) |
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Rhupus | patients with overlapping features of both SLE and RA
serologies consistent with both SLE and RA erosive arthropathy that is atypical for SLE |
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Mixed connective tissue disease (MCTD) | is characterized by overlapping features of SLE, systemic sclerosis (SSc), and polymyositis (PM), and by the presence of high titers of antibodies against U1 ribonucleoprotein (RNP) | MCTD is a distinct clinical entity but it is evident that a subgroup of patients may evolve into another CTD during disease progression. Initial clinical features and autoantibodies can be useful to predict disease evolution
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Undifferentiated connective tissue disease (UCTD) | arthritis and arthralgias, Raynaud phenomenon, and serological findings
signs and symptoms suggestive of a systemic autoimmune disease but do not satisfy the classification criteria for a defined connective tissue disease such as SLE or MCTD |
maintain an undefined profile and have a mild disease course | ||
Systemic sclerosis (SSc) | sclerodactyly, telangiectasias, calcinosis, and malignant hypertension with acute renal failure are more consistent with SSc
positive ANA is present in most patients with SSc, while other serologies such as anti-double-stranded DNA (dsDNA) and anti-Smith (Sm) antibodies antibodies to an antigen called Scl-70 (topoisomerase I) or antibodies to centromere proteins |
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Sjögren’s syndrome | Extra-glandular manifestations
neurologic and pulmonary abnormalities |
keratoconjunctivitis sicca and xerostomia, and characteristic findings on salivary gland biopsy
commonly express antibodies to Ro and La antigens |
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Vasculitis | medium and small vessel vasculitides such as polyarteritis nodosa (PAN), granulomatosis with polyangiitis (GPA) (Wegener’s), or microscopic polyangiitis (MPA)
constitutional symptoms, skin lesions, neuropathy and renal dysfunction |
ANA-negative | ||
Behçet’s syndrome | Oral aphthae
inflammatory eye disease, neurologic disease, vascular disease, and arthritis |
male dominancy and ANA-negative
vascular involvement of any size (small, medium, large) is more common |
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Dermatomyositis (DM) and polymyositis (PM) | positive ANA is observed in approximately 30 percent of patients
Gottron’s papules, a heliotrope eruption and photodistributed poikiloderma (including the shawl and V signs) |
more overt proximal muscle weakness than SLE
Absence of oral ulcers, arthritis, nephritis, and hematologic abnormalities myositis-specific antibodies such as anti-Jo-1 |
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Adult Still’s disease (ASD) | fever, arthritis or arthralgias, and lymphadenopathy | leukocytosis
Negative ANA |
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Kikuchi’s disease | lymphadenopathy as well as fever, myalgias, arthralgias, and, less commonly, hepatosplenomegaly |
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Serum sickness | fever, lymphadenopathy, cutaneous eruptions, and arthralgias
during severe episodes, complement measurements including C3 and C4 can be depressed, as in SLE |
ANAs are typically negative and the course tends to be self-limited | ||
Fibromyalgia | generalized arthralgias, myalgias, and fatigue | SLE patients may have concomitant fibromyalgia as the prevalence of fibromyalgia in patients with systemic rheumatoid diseases is more. | ||
Infections | Viruses |
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Serologic assays can be diagnostic for many of these viruses | |
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Human immunodeficiency virus (HIV) | ||||
Hepatitis B virus (HBV) | ||||
Hepatitis C virus (HCV) | ||||
Cytomegalovirus (CMV) | ||||
Epstein-Barr virus (EBV) | ||||
Bacterias | Salmonella | |||
tuberculosis | ||||
Multiple sclerosis (MS) | cranial neuropathies | Unilateral optic neuritis and pyramidal syndrome, with lesions detected by magnetic resonance imaging (MRI) suggesting dissemination in space and time are characteristic of MS | ||
Malignancies |
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Thrombotic thrombocytopenic purpura (TTP) | fever and thrombocytopenia |
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