Differential Diagnosis Of Systemic Lupus Erythematosus Research Articles

Clinical and laboratory relationships in patients with different variants of the course of systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is characterized by a variability in clinical manifestations and laboratory abnormalities, which creates objective diagnostic difficulties.Objective: to investigate clinical and laboratory parameters in patients with definite and probable SLE.Patients and methods. The investigation enrolled 94 patients, 38 of whom were diagnosed with probable SLE. All the patients underwent immunological examination and unaffected skin biopsies, followed by an immunohistochemical study, the so-called lupus strip test (LST).Results and discussion. The group of patients with definite SLE showed a direct correlation between positive LST and disease activity (r=0.6), acute skin lesion (r=0.42), and elevated anti-double-stranded DNA antibody concentrations (r=0.37), and their inverse correlation with dry syndrome (r=-0.44). In patients with probable SLE, deposition of immunoreactants in the unaffected skin was detected in almost half of the cases, despite lower disease activity and specific antibody deficiency. Thus, LST that is quite easy to use and interpret its results can be used as an additional criterion for the differential diagnosis of SLE, especially in its early stages.

Lupus Pneumonitis Masquerading as Pulmonary Tuberculosis–A Case Study

Introduction: Systemic Lupus erythematosus (SLE) is characterized by production of antibodies against various cellular antigens derived from nucleus, cytoplasm and cell membrane. Pulmonary manifestations of SLE can include a wide spectrum of diseases such as pleuritis, pneumonia, pulmonary embolism, pneumothorax and pulmonary haemorrhage. Acute lupus pneumonitis may mimic tuberculosis or other acute infectious pneumonia and the incidence varies from 0.9% to 11.7%. We report a case of lupus pneumonitis in a case of SLE mimicking pulmonary tuberculosis. Case: An 18 year old girl presented with history cough with expectoration with occasional haemoptysis. She also had history of fever, swelling of hands and feet along with hair loss. On examination she was febrile and dyspneic, with moderate to severe anaemia, tachycardia, tachypnoea, and coarse crepitations over the chest. Sputum for acid fast bacilli, bacterial culture and fungal stains were negative. She was initially treated with broad spectrum antibiotics and then empirically with anti-tubercular therapy (ATT). However, as she failed to respond to ATT, further evaluation was done. Anti-nuclear antibodies and ds DNA were strongly positive. Urine analysis showed nephrotic range proteinuria. High resolution computed tomogram of the chest showed bilateral ground glassing suggestive of lupus pneumonitis (LP). A diagnosis of SLE with LP was made and the patient was put on corticosteroids which led to a dramatic response. Conclusion: SLE has a wide facade of presentations. Keeping this in mind, even in countries where tuberculosis is endemic, the differential diagnosis of SLE and LP should always be considered even where the clinical features and chest X-rays findings are suggestive of pulmonary tuberculosis.

Cell-bound complement activation products in systemic lupus erythematosus: comparison with anti-double-stranded DNA and standard complement measurements

ObjectiveTo compare the performance characteristics of cell-bound complement (C4d) activation products (CBCAPS) on erythrocyte (EC4d) and B cells (BC4d) with antibodies to double-stranded DNA (anti-dsDNA) and complement C3 and C4...

THU0287 Parvovirus B19 Infection Mimics Various Rheumatic Diseases: Clinical Features and Frequency of Fulfilling the Criteria for Rheumatoid Arthritis or Systemic Lupus Erythematosus

BackgroundParvovirus B19 infection in adults has been associated with a variety of rheumatic manifestations and laboratory findings mimicking rheumatic disease.ObjectivesTo explore the clinical features of recent parvovirus B19 infection in...

Differential diagnosis of systemic lupus erythematosus and rheumatoid arthritis with complements C3 and C4 and C-reactive protein

The aim of this study was to analyze the changes in complements C3 and C4 and C-reactive protein (CRP) in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), and to evaluate the role of these indices in the differential diagnosis of SLE and RA. The first 347 patients with SLE, 382 patients with RA and 66 patients with erythema nodosum were selected for the measurement of complement and CRP levels in the serum, the erythema nodosum patients were the control group. The roles of the complements and CRP in the differential diagnosis and disease activity evaluation of SLE and RA were analyzed with SPSS 13.0. Complement C3 and C4 levels were significantly reduced in patients with SLE compared with those in the control group. However, in RA patients, the CRP level was increased. In addition, the levels of complements C3 and C4 in patients with SLE were much lower than those in patients with RA and the level of CRP in RA patients was much higher than that in patients with SLE. The reduction of complement C3 levels in SLE patients, and increase of CRP and complement C4 in patients with RA were associated with a higher risk of joint pain, butterfly rash and oral ulcer. These results show that the disease activity of SLE was negatively correlated with complement C3 and C4, and the disease activity of RA was positively correlated with CRP. With the increase in disease activity, the levels of complements C3 and C4 in patients with SLE were gradually reduced and the level of CRP in patients with RA was increased. There were distinctive differences in the levels of complements C3 and C4 and CRP between SLE and RA patients. The differences are useful in disease activity evaluation and the differential diagnosis of the two diseases that have similar symptoms.

Anti‐nucleosome antibodies in the diagnosis of systemic lupus erythematosus

Objective: To study the prevalence and diagnostic significance of antibodies against nucleosomes in patients with systemic lupus erythematosus (SLE) as compared to five anti‐nuclear antibody (ANA) assays.Methods: The study included 305 patients with SLE, 125 patients with other autoimmune rheumatic diseases, and 415 healthy controls. Anti‐nucleosome antibodies were measured by an enzyme‐linked immunosorbent assay (ELISA) and ANA by immunofluorescence (IF) using Hep‐2 cells. Anti‐double‐stranded DNA (anti‐dsDNA) antibodies were measured by three commercial ELISAs and by IF using Crithidia luciliae as antigen.Results: Compared to three ELISAs for anti‐dsDNA, the anti‐nucleosome assay was less sensitive (30% vs. 29–69%) but equally specific (90% vs. 77–95%) for SLE. The most sensitive test was ANA (76%), and the least sensitive was Crithidia (13%). The correlations between the different assays were good (p<0.001 for all comparisons).Conclusion: The anti‐nucleosome antibody assay does not offer additional information compared to conventionally used anti‐dsDNA tests in the differential diagnosis of SLE.

Contemporary concepts for the clinical and laboratory evaluation of systemic lupus erythematosus and "lupus-like" syndromes.

Systemic lupus erythematosus (SLE) is a nonorgan-specific autoimmune disease which affects multiple organ systems and is multifactorial in etiology. SLE is the prototypic systemic rheumatic disease with immune dysregulation characterized by (1) polyclonal activation of B-cells and (2) production of a large spectrum of autoantibodies with a marked preference for nuclear and intracellular antigens. The clinical and laboratory manifestations and criteria for classification and diagnosis of systemic lupus erythematosus, lupus-like syndromes, and various subsets of systemic lupus erythematosus, are reviewed. The differential diagnosis of SLE and related diseases is described with correlation of specific intracellular autoantibodies.