Tuesday, 23 Apr 2019

You are here

Diagnosing Early Lupus from Mimics

A multicenter study of early systemic lupus erythematosus (SLE) patients examined manifestations at disease onset and found that certain clinical features can help to distinguish early SLE from other SLE‐mimicking conditions. 

The cohorts included 389 patients with early SLE and 227 patients with SLE‐mimicking conditions. The diagnosis was based on the 1997 American College of Rheumatology (ACR) SLE classification criteria and the 2012 Systemic Lupus International Collaborating Clinics (SLICC) SLE classification criteria.

They found that features that were more common in early SLE than in SLE‐mimicking conditions included:

  • Unexplained fever 34.5% versus 13.7%, respectively (P < 0.001)
  • Anti–double‐stranded DNA, anti–β2‐glycoprotein I antibodies, positive Coombs’ test results, autoimmune hemolytic anemia, hypocomplementemia, and leukopenia 

Fatures that were less common in early SLE than in SLE‐mimicking conditions included:

  • Raynaud's phenomenon (22.1% versus 48.5%; P < 0.001)
  • Sicca symptoms (4.4% versus 34.4%; P < 0.001)
  • Dysphagia (0.3% versus 6.2%; P < 0.001)
  • Fatigue (28.3% versus 37.0%; P = 0.024)

Fewer patients with early SLE were not identified as having early SLE with use of the SLICC criteria compared to the ACR criteria (16.5% versus 33.9%), but the ACR criteria demonstrated higher specificity than the SLICC criteria (91.6% versus 82.4%).

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

EULAR 2019 Update to Lupus Management

The goal of SLE treatment is remission or low disease activity and flare prevention. Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight. Glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent). Appropriate initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can be tailored to the clinical scenarios and may allow for tapering or discontinuation of GC.

Mortality Risk Factors in Systemic Sclerosis

A French cohort study of 625 systemic sclerosis (SStc) patients has found a significantly increased mortality risk that can be predicted by common clinical variables.

In addition to a multicenter prospective study, investigators performed a metanalysis on SSc standarized mortality ratios (SMR) and hazard ratios of prognosis factors.

Better Tests Ahead in Lupus

The advent of "big data" and "-omics" technologies offers hope that clinicians will soon have better diagnostics for systemic lupus erythematosus, rheumatologists here were told.

GCA Relapse Risk High with Steroids

Prior to the introduction of tocilizumab to manage giant cell arteritis (GCA), glucocorticoids (GC) have been the mainstay of therapy, but has been limited by relapses in disease. A recent metanalysis shows that relapses occur in nearly half of patients and are related to the duration of therapy rather than the initial dose of GC.

A literature review found 34 studies (2,505 patients) from 8 RCTs of GCA patients only treated with GC.

Presenting Features of Early SLE

What clinical features best identify early systemic lupus erythematosus (SLE) patients from mimics?  A multicenter, multinational study aimed to evaluate manifestations at disease onset and to compare early SLE manifestations to those of diseases mimicking SLE.