Systemic lupus erythematosus(SLE): Diagnosis
SLE eliminates other diseases and diagnoses based on the judgment of an experienced doctor who knows the characteristic clinical symptoms. This approach can be difficult to diagnose because of the wide variety of SLE clinical manifestations. Currently, there is no SLE diagnostic criteria. However, SLE diagnosis is approached by referring to '2012 SLICC classification criteria' and '1997 ACR classification criteria' that classified SLE for the study. According to the 2012 SLICC criteria, SLEs must meet four or more of the 17 criteria (one must meet one of 11 clinical criteria and one must be one of six immunological criteria) A SLE characteristic antibody (ANA, anti-dsDNA) can be detected in the blood and diagnosed when there is a confirmed lupus nephritis by a kidney biopsy. However, even if you do not meet this criterion, you may suspect SLE when you are satisfied with '2 or 3 out of 17 + one or more related symptoms that are not SLE-specific'.
Because the symptoms that appear in SLE can be accompanied by various other diseases, it is necessary to diagnose it from the following diseases.
1) Rheumatoid arthritis (RA): Early RA is difficult to distinguish from arthritis symptoms of SLE. Joint symptoms are similar, but joint deformation of SLE patients can often be reduced and few erosive areas appear on the X-ray. Other symptoms of RA (anemia, fatigue, serositis, subcu, nodules, sicca symptoms) are more common in patients with severe RA, and in addition to these symptoms, the presence of anti-CCP antibodies is more like RA. In half of RA, ANA is also positive. Conversely, RF appears in 1/3 of SLE patients.
2) RHUPUS: overlapping syndrome of RA and SLE. Serologic results are consistent with SLE and RA, and SLE is associated with rare erosive arthropathy.
3) Mixed connective tissue disease (MCTD): overlapping syndrome of SLE, systemic sclerosis (SSc), and polymyositis (PM). Anti-U1 ribonucleoprotein (RNP) antibodies are detected as high-titer. Diagnosis is difficult because the characteristic symptoms of MCTD are sequential.
4) Undifferentiated connective tissue disease (UCTD) - A symptom of systemic autoimmune disease that does not meet the criteria for each disease. These patients have serological results that are difficult to distinguish from joint pain, Raynaud phenomenon, and early SLE.
5) Systemic sclerosis (SSc): Raynaud phenomenon and gastroesophageal reflux are common symptoms of SSc. However, these symptoms are nonspecific symptoms that can occur in normal or SLE patients. On the other hand, sclerodactyly, telangiectasias, calcinosis, and malignant hypertension with acute renal failure are more likely SSc. Most patients have serologic results of ANA (+) and Anti-dsDNA (-) Anti-Sm (-). Antibodies against Scl70 (topoisomerase I) and centromere proteins are also characteristic of SSc patients.
6) Sjögren's syndrome: Sjögren's syndrome patients may show neurologic / pulmonary abnormalities symptoms in SLE patients, but Sjögren's syndrome patients have salivary gland biopsies that are not usually seen in more objective keratoconjunctivitis sicca, xerostomia, and SLE patients. Serologic results of anti-Ro / La (+) are predominant in patients with Sjögren's syndrome.
7) Patients with Vasculitis-mediated and small vessel vasculitides (eg polyarteritis nodosa, granulomatosis with polyangiitis (Wegener's), or microscopic polyangiitis (MPA)) may present with symptoms such as skin lesions, neurological diseases, However, patients with vasculitis often have ANA (-) results.
8) Behçet's syndrome - Oral ulcers are the most common symptom in patients with Vesic disease, and these symptoms may also occur in SLE patients. In addition, inflammatory eye disease, neurologic disease, vascular disease, arthritis may occur in both Vetch and SLE patients. However, patients with Vesic disease are usually male and show ANA (-). In addition, patients with vesiculosis (small, medium, large) have vasculitis in various sized blood vessels.
In addition, the following should be distinguished.
9) Dermatomyositis (DM) and polymyositis (PM)
10) Adult Still's disease (ASD)
11) Kikuchi's disease
12) Serum sickness
13) Fibromyalgia
14) Infections: CMV, EBV, Human parvovirus B19, HIV, HBV, HCV
15) Multiple sclerosis (MS)
16) Malignancies
17) Thrombotic thrombocytopenic purpura (TTP)
Because the symptoms that appear in SLE can be accompanied by various other diseases, it is necessary to diagnose it from the following diseases.
1) Rheumatoid arthritis (RA): Early RA is difficult to distinguish from arthritis symptoms of SLE. Joint symptoms are similar, but joint deformation of SLE patients can often be reduced and few erosive areas appear on the X-ray. Other symptoms of RA (anemia, fatigue, serositis, subcu, nodules, sicca symptoms) are more common in patients with severe RA, and in addition to these symptoms, the presence of anti-CCP antibodies is more like RA. In half of RA, ANA is also positive. Conversely, RF appears in 1/3 of SLE patients.
2) RHUPUS: overlapping syndrome of RA and SLE. Serologic results are consistent with SLE and RA, and SLE is associated with rare erosive arthropathy.
3) Mixed connective tissue disease (MCTD): overlapping syndrome of SLE, systemic sclerosis (SSc), and polymyositis (PM). Anti-U1 ribonucleoprotein (RNP) antibodies are detected as high-titer. Diagnosis is difficult because the characteristic symptoms of MCTD are sequential.
4) Undifferentiated connective tissue disease (UCTD) - A symptom of systemic autoimmune disease that does not meet the criteria for each disease. These patients have serological results that are difficult to distinguish from joint pain, Raynaud phenomenon, and early SLE.
5) Systemic sclerosis (SSc): Raynaud phenomenon and gastroesophageal reflux are common symptoms of SSc. However, these symptoms are nonspecific symptoms that can occur in normal or SLE patients. On the other hand, sclerodactyly, telangiectasias, calcinosis, and malignant hypertension with acute renal failure are more likely SSc. Most patients have serologic results of ANA (+) and Anti-dsDNA (-) Anti-Sm (-). Antibodies against Scl70 (topoisomerase I) and centromere proteins are also characteristic of SSc patients.
6) Sjögren's syndrome: Sjögren's syndrome patients may show neurologic / pulmonary abnormalities symptoms in SLE patients, but Sjögren's syndrome patients have salivary gland biopsies that are not usually seen in more objective keratoconjunctivitis sicca, xerostomia, and SLE patients. Serologic results of anti-Ro / La (+) are predominant in patients with Sjögren's syndrome.
7) Patients with Vasculitis-mediated and small vessel vasculitides (eg polyarteritis nodosa, granulomatosis with polyangiitis (Wegener's), or microscopic polyangiitis (MPA)) may present with symptoms such as skin lesions, neurological diseases, However, patients with vasculitis often have ANA (-) results.
8) Behçet's syndrome - Oral ulcers are the most common symptom in patients with Vesic disease, and these symptoms may also occur in SLE patients. In addition, inflammatory eye disease, neurologic disease, vascular disease, arthritis may occur in both Vetch and SLE patients. However, patients with Vesic disease are usually male and show ANA (-). In addition, patients with vesiculosis (small, medium, large) have vasculitis in various sized blood vessels.
In addition, the following should be distinguished.
9) Dermatomyositis (DM) and polymyositis (PM)
10) Adult Still's disease (ASD)
11) Kikuchi's disease
12) Serum sickness
13) Fibromyalgia
14) Infections: CMV, EBV, Human parvovirus B19, HIV, HBV, HCV
15) Multiple sclerosis (MS)
16) Malignancies
17) Thrombotic thrombocytopenic purpura (TTP)
