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]], such as [[rheumatoid arthritis]](RA), [[mixed connective tissue disease]] (MCTD), [[systemic sclerosis]] (SSc), [[dermatomyositis]] (DM), [[polymyositis]](PM), and other [[autoimmune diseases]].
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 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.  
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]] and [[rash]] =====
===== Differetiating SLE from other diseases that cause [[arthritis]] and [[rash]] =====
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! align="center" style="background:#4479BA; color: #FFFFFF;" |Anti-dsDNA
! align="center" style="background:#4479BA; color: #FFFFFF;" |Anti-dsDNA
|-
|-
| colspan="2" align="center" style="background:#DCDCDC;" |[[Systemic lupus erythematosus]]
| 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>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
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| -
| -
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Malar rash and photosensitivity
|[[Malar rash]] and [[photosensitivity]]
|
|
|-
|-
| colspan="2" align="center" style="background:#DCDCDC;" |[[Rheumatoid arthritis]] ([[Rheumatoid arthritis|RA]])
| 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>
| +
| +
| +
| +
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| -
| -
| +
| +
|Subcutaneous nodules
|[[Subcutaneous]] [[nodules]]
|
|Erosive [[arthropathy]]
*
|-
|-
| colspan="2" align="center" style="background:#DCDCDC;" |Rhupus
| colspan="2" align="center" style="background:#DCDCDC;" |Rhupus
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|↑
|↑
| +
| +
|
|[[Malar rash]] and [[photosensitivity]]
|Erosive [[arthropathy]]
|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>
| 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>
|
|<nowiki>-</nowiki>
|
| -
|
| -
| +
| +
|Small and large joints
|Small and large joints
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| -
| -
| +
| +
|
|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)
|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)
| colspan="2" align="center" style="background:#DCDCDC;" |[[Undifferentiated connective tissue disease]] (UCTD)
| +
| +
|
| -
|
| -
|
| -
|Lower extremity
|Lower extremity
|↑
|↑
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| -
| -
| +
| +
|erythematous macules, patches, or papules with delicate scale
|[[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)
| colspan="2" align="center" style="background:#DCDCDC;" |[[Systemic sclerosis]] (SSc)
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|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|
|Lower extremity
|↑↑
|↑↑
| -
| -
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|↑
|↑
| +
| +
|skin thickening and hardening and edematous swelling and erythema
|[[Hyperkeratosis]], [[edema]], and [[erythema]]
|[[Sclerodactyly]], [[Telangiectasias]], [[Calcinosis]], [[Malignant hypertension]], [[acute renal failure]]
|[[Sclerodactyly]], [[Telangiectasias]], [[Calcinosis]], [[Malignant hypertension]], [[acute renal failure]]
|-
|-
| colspan="2" align="center" style="background:#DCDCDC;" |Sjögren’s syndrome
| 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>
15485020
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|
| -
|
| -
|Lower extremity, axiallary creases
|[[Lower extremity]], axiallary creases
|↑
|↑
| -
| -
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| -
| -
| -
| -
|xerosis, scaly skin, annular erythema
|[[Xerosis]], scaly skin, annular [[erythema]]


|[[Keratoconjunctivitis sicca]]
|[[Keratoconjunctivitis sicca]]
|-
|-
| 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]]
|
| -
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
| -
|Distal extremity
|Distal extremity
| -
| -
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|-
|-
| align="center" style="background:#DCDCDC;" |[[Takayasu's arteritis|Takayasu]]
| align="center" style="background:#DCDCDC;" |[[Takayasu's arteritis|Takayasu]]
|
|<nowiki>-</nowiki>
| +/-
| +/-
| +/-
| +/-
|
| -
|Transient extremity
|Transient extremity
| -
| -
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| -
| -
| -
| -
|Erythema nodosum, pyoderma gangrenosum
|[[Erythema nodosum]], [[pyoderma gangrenosum]]
|Absent or weak peripheral pulse
|Absent or weak peripheral pulse
|-
|-
| align="center" style="background:#DCDCDC;" |[[Polyarteritis nodosa|Poly-arteritis nodosa]]
| align="center" style="background:#DCDCDC;" |[[Polyarteritis nodosa|Poly-arteritis nodosa]]
|
| -
| +/-
| +/-
|
| -
|
| -
|General and mild
|General and mild
| -
| -
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| -
| -
| -
| -
|Tender erythematous nodules, purpura, livedo reticularis, bullous or vesicular eruption
|[[Tenderness|Tender]] [[Erythematous rash|erythematous nodules]], [[purpura]], [[livedo reticularis]], [[bullous]] or [[Vesicular|vesicular eruption]]
|Testicular pain or tenderness and neuropathies
|[[Testicular pain]] or [[tenderness]] and [[neuropathies]]
|-
|-
| colspan="2" align="center" style="background:#DCDCDC;" |Behçet’s syndrome
| colspan="2" align="center" style="background:#DCDCDC;" |[[Behçet's Syndrome|Behçet’s syndrome]]
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|
| -
|medium and large joints
|medium and large joints
| -
| -
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| -
| -
| -
| -
|
| -
|Recurrent and usually painful mucocutaneous ulcers, acneiform lesions, papulo-vesiculo-pustular eruptions, superficial thrombophlebitis
|Recurrent and usually painful [[mucocutaneous]] ulcers, [[Acneiform eruption|acneiform]] [[lesions]], papulo-vesiculo-[[Pustular rash|pustular]] eruptions, superficial [[thrombophlebitis]]
|Male dominancy
|Male dominancy
|-
|-
| colspan="2" align="center" style="background:#DCDCDC;" |Kikuchi’s disease
| 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>
|
| -
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|
| -
|
| -
|
|medium and large joints
|↑/↓
|↑/↓
| -
| -
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| -
| -
| -
| -
|
| -
|Transient skin rashes, malar rash, erythematous macules, patches, papules, or plaques
|Transient skin [[rashes]], [[malar rash]], [[Macule|erythematous macules]], patches, [[papules]], or [[plaques]]
|May be associated with SLE
|May be associated with SLE
|-
|-
| colspan="2" align="center" style="background:#DCDCDC;" |Serum sickness
| colspan="2" align="center" style="background:#DCDCDC;" |[[Serum sickness]]
|<nowiki>+/-</nowiki>
| +
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|
| -
|
|General
| -
| -
| -
| -
| -
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| -
| -
| -
| -
|
|[[Pruritic disorders|Pruritic rash]], [[urticaria]] and/or serpiginous [[Rash|macular rash]]
|Pruritic rash, urticarial and/or serpiginous macular rash
|Self-limited
|Self-limited
|-
|-
| colspan="2" align="center" style="background:#DCDCDC;" |Psoriatic arthritis
| colspan="2" align="center" style="background:#DCDCDC;" |[[Psoriatic arthritis]]
|
| -
|
| -
|
| -
|
| -
|Small and large joints
|Small and large joints
| -
| -
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| -
| -
| -
| -
|
| -
|Psoriasis and onychodystrophy
|[[Psoriasis]] and [[onychodystrophy]]
|dactylitis (“sausage digits”)
|[[Dactylitis]] (“sausage digits”)
|-
|-
| colspan="2" align="center" style="background:#DCDCDC;" |Human [[parvovirus]] B19 infection
| colspan="2" align="center" style="background:#DCDCDC;" |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>
PMC2219874
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
| -
|
| -
|Small joints
|Small joints
| -
| -
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| -
| -
| -
| -
|
| -
|Erythematous rashes
|[[Erythematous rash|Erythematous rashes]]
|Rare in adults, fifth's disease in children
|Rare in adults, [[Fifth disease|fifth's disease]] in children
|}
|}


Revision as of 20:47, 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 + + + + Small and large joints ↑ ↑ ↑ ↑ ↑ - ↑ + Malar rash and photosensitivity Erosive arthropathy
Mixed connective tissue disease (MCTD)[3] - - - + 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) + - - - 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) +/- + + +/- Lower extremity ↑↑ - - - ↑ - ↑ + Hyperkeratosis, edema, and erythema Sclerodactyly, Telangiectasias, Calcinosis, Malignant hypertension, acute renal failure
Sjögren’s syndrome[4] +/- +/- - - 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[5] - +/- - - medium and large joints ↑/↓ - - - - - - - Transient skin rashes, malar rash, erythematous macules, patches, papules, or plaques May be associated with SLE
Serum sickness + + +/- - General - - - - - - - - Pruritic rash, urticaria and/or serpiginous macular rash Self-limited
Psoriatic arthritis - - - - Small and large joints - - - - - - - - Psoriasis and onychodystrophy Dactylitis (“sausage digits”)
Human parvovirus B19 infection[6] + + - - Small joints - - - - - - - - Erythematous rashes Rare in adults, fifth's disease in children

References

  1. ↑ 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.
  2. ↑ Lee DM, Weinblatt ME (2001). "Rheumatoid arthritis". Lancet. 358 (9285): 903–11. doi:10.1016/S0140-6736(01)06075-5. PMID 11567728.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
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