Differentiating systemic lupus erythematosus from other diseases: Difference between revisions
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{{CMG}}; {{AE}}{{MIR}} | {{CMG}}; {{AE}}{{MIR}} | ||
==Overview== | ==Overview== | ||
Systemic lupus erythematosus (SLE) must be differentiated from other diseases that cause skin rash, [[arthritis]], positive [[autoimmune]] serology, weight loss, [[Fever|fevers]] and [[chronic pain]] | Systemic lupus erythematosus (SLE) must be differentiated from other diseases that cause skin rash, [[arthritis]], positive [[autoimmune]] serology, weight loss, [[Fever|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== | ==Differentiating systemic lupus erythematosus from other diseases== | ||
Systemic lupus erythematosus (SLE) must be differentiated from other diseases that cause [[arthritis]], positive [[autoimmune]] serology, and [[ | Systemic lupus erythematosus (SLE) must be differentiated from other diseases that cause skin rash, [[arthritis]], positive [[autoimmune]] serology, weight loss, [[Fever|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]], positive [[autoimmune]] serology, and [[Constitutional acrocyanosis|constitutional]] symptoms ===== | ===== Differetiating SLE from other diseases that cause [[arthritis]], positive [[autoimmune]] serology, and [[Constitutional acrocyanosis|constitutional]] symptoms ===== | ||
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Overlapping Features | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Overlapping Features | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Distinguishing/specific features | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Distinguishing/specific features | ||
|- | |- | ||
| colspan="2" |Rheumatoid arthritis (RA) | | colspan="2" |[[Rheumatoid arthritis]] ([[Rheumatoid arthritis|RA]]) | ||
| | | | ||
* [[Serositis]] | * [[Serositis]] | ||
* Sicca symptoms | * Sicca symptoms (photosensitivity, dry eyes, dry mouth) | ||
* [[Subcutaneous]] nodules | * [[Subcutaneous]] nodules | ||
* [[Anemia]] | * [[Anemia]] | ||
* [[Fatigue]] | * [[Fatigue]] | ||
* Joint tenderness and swelling especially in early RA | * Joint tenderness and swelling especially in early RA | ||
* [[Swan neck deformity|Swan neck deformities]], [[ulnar deviation]], and soft tissue laxity more common in RA but may seen in SLE as well | * [[Swan neck deformity|Swan neck deformities]], [[ulnar deviation]], and [[soft tissue]] laxity more common in RA but may seen in SLE as well | ||
* Positive ANA: more common in SLE | * Positive [[Antinuclear antibodies|ANA]]: more common in SLE | ||
* Positive RF: more common in RA | * Positive [[Rheumatoid factor]] ([[Rheumatoid factor|RF]]): more common in [[Rheumatoid arthritis|RA]] | ||
| | | | ||
* Joint deformities in RA are often more extensive, and frequently erosive on plain radiographs | * Joint deformities in [[Rheumatoid arthritis|RA]] are often more extensive, and frequently erosive on plain radiographs | ||
* Presence of anti-cyclic citrullinated peptides (CCP) | * Presence of anti-cyclic citrullinated peptides (CCP) | ||
|- | |- | ||
| colspan="2" |Rhupus | | colspan="2" |Rhupus | ||
| | | | ||
* Patients with overlapping features of both SLE and RA | * Patients with overlapping features of both SLE and [[Rheumatoid arthritis|RA]] | ||
* Serologies consistent with both SLE and RA | * Serologies consistent with both SLE and [[Rheumatoid arthritis|RA]] | ||
| | | | ||
* Erosive [[arthropathy]] that is atypical for SLE | * Erosive [[arthropathy]] that is atypical for SLE | ||
|- | |- | ||
| colspan="2" |Mixed connective tissue disease (MCTD) | | colspan="2" |[[Mixed connective tissue disease]] (MCTD) | ||
| | | | ||
* A mix disease with overlapping features of SLE, [[systemic sclerosis]] (SSc), and [[polymyositis]] (PM) | * A mix disease with overlapping features of SLE, [[systemic sclerosis]] (SSc), and [[polymyositis]] (PM) | ||
* Antibodies against U1 ribonucleoprotein (RNP) | * [[Antibodies]] against U1 ribonucleoprotein (RNP) | ||
| | | | ||
* MCTD patients may evolve into another [[connective tissue disorder]] during disease progression | * MCTD patients may evolve into another [[connective tissue disorder]] during disease progression | ||
* Prediction of disease evolution may be possible by recognizing [[autoantibodies]]<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> | * Prediction of disease evolution may be possible by recognizing [[autoantibodies]]<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" |Undifferentiated connective tissue disease (UCTD) | | colspan="2" |[[Undifferentiated connective tissue disease]] (UCTD) | ||
| | | | ||
* [[Arthritis]] and [[Arthralgia|arthralgias]] | * [[Arthritis]] and [[Arthralgia|arthralgias]] | ||
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| | | | ||
* Mild disease course | * Mild disease course | ||
|- | |- | ||
| colspan="2" |Systemic sclerosis (SSc) | | colspan="2" |[[Systemic sclerosis]] (SSc) | ||
| | | | ||
* Positive [[ANA]] | * Positive [[ANA]] | ||
* Positive anti-double-stranded DNA (dsDNA) | * Positive anti-double-stranded DNA (anti-dsDNA) | ||
* Positive anti-Smith (Sm) antibodies | * Positive anti-Smith (Sm) [[antibodies]] | ||
| | | | ||
* [[Sclerodactyly]] | * [[Sclerodactyly]] | ||
| Line 69: | Line 64: | ||
* [[Calcinosis]] | * [[Calcinosis]] | ||
* [[Malignant hypertension]] with [[acute renal failure]] | * [[Malignant hypertension]] with [[acute renal failure]] | ||
* Positive antibodies to an antigen called Scl-70 (topoisomerase I) | * Positive [[antibodies]] to an [[antigen]] called Scl-70 ([[Type I topoisomerase|topoisomerase I]]) | ||
* Positive antibodies to centromere proteins | * Positive [[antibodies]] to [[centromere]] proteins | ||
|- | |- | ||
| colspan="2" |Sjögren’s syndrome | | colspan="2" |Sjögren’s syndrome | ||
| | | | ||
* Extra-glandular manifestations | * Extra-glandular manifestations | ||
* Neurologic abnormalities | * [[Neurologic]] abnormalities | ||
* Pulmonary abnormalities | * [[Pulmonary]] abnormalities | ||
* Positive antibodies to Ro and La antigens | * Positive [[antibodies]] to Ro and La antigens | ||
| | | | ||
* [[Keratoconjunctivitis sicca]] | * [[Keratoconjunctivitis sicca]] | ||
* [[Xerostomia]] | * [[Xerostomia]] | ||
* Salivary gland biopsy: Focal collection or collections of tightly aggregated lymphocytes, termed lymphocytic foci, which are typically periductal | * Salivary gland [[biopsy]]: Focal collection or collections of tightly aggregated [[Lymphocyte|lymphocytes]], termed [[lymphocytic]] foci, which are typically periductal | ||
|- | |- | ||
| colspan="2" |Vasculitis | | colspan="2" |Vasculitis | ||
| | | | ||
* Medium and small vessel vasculitides: | * Medium and small vessel [[vasculitides]]: | ||
** [[Polyarteritis nodosa]] (PAN) | ** [[Polyarteritis nodosa]] (PAN) | ||
** [[Granulomatosis with polyangiitis]] (GPA) (Wegener’s) | ** [[Granulomatosis with polyangiitis]] (GPA) (Wegener’s) | ||
** [[Microscopic polyangiitis]] (MPA) | ** [[Microscopic polyangiitis]] (MPA) | ||
* Constitutional symptoms | * Constitutional symptoms ([[fever]], chronic pain, weight changes) | ||
* Skin lesions | * Skin lesions | ||
* [[Neuropathy]] | * [[Neuropathy]] | ||
* Renal dysfunction | * [[Renal]] dysfunction | ||
| | | | ||
* [[ANA]]-negative | |||
|- | |- | ||
| colspan="2" |Behçet’s syndrome | | colspan="2" |Behçet’s syndrome | ||
| Line 104: | Line 96: | ||
* Oral aphthae | * Oral aphthae | ||
* Inflammatory eye disease | * Inflammatory eye disease | ||
* Neurologic disease | * [[Neurologic]] disease | ||
* Vascular disease | * [[Vascular]] disease | ||
* [[Arthritis]] | * [[Arthritis]] | ||
| | | | ||
* Male dominancy | * Male dominancy | ||
* ANA-negative | * [[ANA]]-negative | ||
|- | |- | ||
| colspan="2" |Dermatomyositis (DM) and polymyositis (PM) | | colspan="2" |Dermatomyositis (DM) and polymyositis (PM) | ||
| | | | ||
* Positive ANA: In approximately 30 percent of patients | * Positive [[ANA]]: In approximately 30 percent of patients | ||
* Gottron’s papules: A heliotrope eruption and photodistributed [[Poikiloderma of civatte|poikiloderma]] ( | * [[Gottron's papules|Gottron’s papules]]: A heliotrope eruption and photodistributed [[Poikiloderma of civatte|poikiloderma]] (found on the dorsum of the hands) | ||
| | | | ||
* More overt proximal muscle weakness than SLE | * More overt proximal muscle weakness than SLE | ||
* Absence of oral ulcers, [[arthritis]], [[nephritis]], and hematologic abnormalities | * Absence of oral ulcers, [[arthritis]], [[nephritis]], and hematologic abnormalities | ||
* [[Myositis]]-specific antibodies such as anti-Jo-1 | * [[Myositis]]-specific antibodies such as anti-Jo-1 | ||
|- | |- | ||
| colspan="2" |Adult Still’s disease (ASD) | | colspan="2" |Adult Still’s disease (ASD) | ||
| | | | ||
* [[Fever]] | * [[Fever]] | ||
* [[Arthritis]] or arthralgias | * [[Arthritis]] or [[Arthralgia|arthralgias]] | ||
* [[Lymphadenopathy]] | * [[Lymphadenopathy]] | ||
| | | | ||
* [[Leukocytosis]] | * [[Leukocytosis]] | ||
* Negative ANA | * Negative [[ANA]] | ||
|- | |- | ||
| colspan="2" |Kikuchi’s disease | | colspan="2" |Kikuchi’s disease | ||
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* May be associated with SLE | * May be associated with SLE | ||
* Spontaneous remission usually occurring within four months | * Spontaneous remission usually occurring within four months | ||
* Lymph node biopsy: Histiocytic cellular infiltrate | * [[Lymph node]] [[biopsy]]: [[Histiocytic]] cellular infiltrate | ||
|- | |- | ||
| colspan="2" |Serum sickness | | colspan="2" |Serum sickness | ||
| | | | ||
* Fever | * [[Fever]] | ||
* [[Lymphadenopathy]] | * [[Lymphadenopathy]] | ||
* Cutaneous eruptions | * Cutaneous eruptions | ||
* [[Arthralgia|Arthralgias]] | * [[Arthralgia|Arthralgias]] | ||
* Depressed levels of C3 and C4 during severe episodes | * Depressed levels of [[C3 (complement)|C3]] and [[Complement|C4]] during severe episodes | ||
| | | | ||
* Negative ANA | * Negative [[Antinuclear antibodies|ANA]] | ||
* Self-limited | * Self-limited | ||
|- | |- | ||
| colspan="2" |Fibromyalgia | | colspan="2" |Fibromyalgia | ||
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* [[Fatigue]] | * [[Fatigue]] | ||
| | | | ||
* SLE patients may have concomitant [[fibromyalgia]] as the prevalence of fibromyalgia in patients with systemic rheumatoid diseases is more | * SLE patients may have concomitant [[fibromyalgia]] as the prevalence of [[fibromyalgia]] in patients with systemic rheumatoid diseases is more | ||
|- | |- | ||
| rowspan="9" |Infections | | rowspan="9" |Infections | ||
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| | | | ||
* Human [[parvovirus]] B19: | * Human [[parvovirus]] B19: | ||
** Flu-like symptoms | ** Flu-like symptoms ([[fever]],[[malaise]], [[dry cough]], loss of appetite, [[body aches]]) | ||
** Hematologic abnormalities such as [[leukopenia]] and [[thrombocytopenia]] | ** Hematologic abnormalities such as [[leukopenia]] and [[thrombocytopenia]] | ||
** [[Arthralgias]] or [[arthritis]] | ** [[Arthralgias]] or [[arthritis]] | ||
| rowspan="9" | | | rowspan="9" | | ||
* Serologic assays can be diagnostic for many of these viruses | * Serologic assays can be diagnostic for many of these viruses | ||
|- | |- | ||
| | | | ||
* [[Epstein Barr virus|EBV]] | * [[Epstein Barr virus|EBV]] | ||
** May lead to a positive ANA<ref name="pmid3020161">{{cite journal |vauthors=Sculley DG, Sculley TB, Pope JH |title=Reactions of sera from patients with rheumatoid arthritis, systemic lupus erythematosus and infectious mononucleosis to Epstein-Barr virus-induced polypeptides |journal=J. Gen. Virol. |volume=67 ( Pt 10) |issue= |pages=2253–8 |year=1986 |pmid=3020161 |doi=10.1099/0022-1317-67-10-2253 |url=}}</ref> | ** May lead to a positive [[ANA]]<ref name="pmid3020161">{{cite journal |vauthors=Sculley DG, Sculley TB, Pope JH |title=Reactions of sera from patients with rheumatoid arthritis, systemic lupus erythematosus and infectious mononucleosis to Epstein-Barr virus-induced polypeptides |journal=J. Gen. Virol. |volume=67 ( Pt 10) |issue= |pages=2253–8 |year=1986 |pmid=3020161 |doi=10.1099/0022-1317-67-10-2253 |url=}}</ref> | ||
|- | |- | ||
|Human immunodeficiency virus (HIV) | |[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] ([[HIV]]) | ||
|- | |- | ||
|Hepatitis B virus ([[HBV]]) | |[[Hepatitis B virus]] ([[HBV]]) | ||
|- | |- | ||
|Hepatitis C virus ([[HCV]]) | |[[Hepatitis C virus]] ([[HCV]]) | ||
|- | |- | ||
|Cytomegalovirus ([[CMV]]) | |[[Cytomegalovirus]] ([[CMV]]) | ||
|- | |- | ||
|Epstein-Barr virus ([[EBV]]) | |[[Epstein Barr virus|Epstein-Barr virus]] ([[EBV]]) | ||
|- | |- | ||
| rowspan="2" |Bacterias | | rowspan="2" |Bacterias | ||
|[[Salmonella]] | |[[Salmonella]] | ||
|- | |- | ||
|[[Mycobacterium tuberculosis]] | |[[Mycobacterium tuberculosis]] | ||
|- | |- | ||
| colspan="2" |Multiple sclerosis (MS) | | colspan="2" |Multiple sclerosis (MS) | ||
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* Unilateral [[optic neuritis]] | * Unilateral [[optic neuritis]] | ||
* Pyramidal syndrome | * Pyramidal syndrome | ||
* Lesions detected by magnetic resonance imaging (MRI) suggesting dissemination in space and time | * Lesions detected by magnetic resonance imaging ([[MRI]]) suggesting dissemination in space and time | ||
|- | |- | ||
| colspan="2" |Malignancies | | colspan="2" |Malignancies | ||
| Line 228: | Line 203: | ||
** [[Lactate dehydrogenase|Increased lactate dehydrogenase (LDH)]] | ** [[Lactate dehydrogenase|Increased lactate dehydrogenase (LDH)]] | ||
** Excisional tissue biopsy specially from lymph nodes for diagnosis | ** Excisional tissue biopsy specially from lymph nodes for diagnosis | ||
|- | |- | ||
| colspan="2" |Thrombotic thrombocytopenic purpura (TTP) | | colspan="2" |Thrombotic thrombocytopenic purpura (TTP) | ||
| Line 239: | Line 213: | ||
* Fluctuating neurological manifestations | * Fluctuating neurological manifestations | ||
* Low levels of ADAMSTS13 | * Low levels of ADAMSTS13 | ||
|} | |} | ||
Revision as of 17:10, 3 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, positive autoimmune serology, and constitutional symptoms
| Overlapping Features | Distinguishing/specific features | ||
|---|---|---|---|
| Rheumatoid arthritis (RA) |
|
| |
| Rhupus |
| ||
| Mixed connective tissue disease (MCTD) |
|
| |
| Undifferentiated connective tissue disease (UCTD) |
|
| |
| Systemic sclerosis (SSc) |
|
| |
| Sjögren’s syndrome |
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| |
| Vasculitis |
|
| |
| Behçet’s syndrome |
|
| |
| Dermatomyositis (DM) and polymyositis (PM) |
|
||
| Adult Still’s disease (ASD) |
| ||
| Kikuchi’s disease |
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| Serum sickness |
|
| |
| Fibromyalgia |
| ||
| Infections | 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 | ||
| Mycobacterium tuberculosis | |||
| Multiple sclerosis (MS) |
|
| |
| Malignancies |
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| Thrombotic thrombocytopenic purpura (TTP) |
|
| |
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.
- ↑ Sculley DG, Sculley TB, Pope JH (1986). "Reactions of sera from patients with rheumatoid arthritis, systemic lupus erythematosus and infectious mononucleosis to Epstein-Barr virus-induced polypeptides". J. Gen. Virol. 67 ( Pt 10): 2253–8. doi:10.1099/0022-1317-67-10-2253. PMID 3020161.