Differentiating systemic lupus erythematosus from other diseases
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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
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 | + | + | + | - | 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 |
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| 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 | |||
| 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
PMC2219874 |
+ | + | Small joints | - | - | - | - | - | - | - | Erythematous rashes | Rare in adults, fifth's disease in children | ||||
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.