Clinical manifestations differentiating early-onset systemic lupus erythematosus (SLE) from SLE-mimicking conditions have been identified, according to a study recently published in Arthritis & Rheumatology.

This study included 389 individuals with SLE and 227 with conditions that mimicked SLE. Baseline data were collected using Academic Lupus Centers located in 4 continents and included individuals who had been referred for potential SLE within the past 3 years with less than 1 year of symptoms. The study researchers compared individuals with SLE and those with symptoms mimicking SLE in terms of serological and clinical characteristics.

Those with early SLE showed higher rates of unexplained fever than those with SLE-mimicking conditions (34.5% vs 13%; P <.001).


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Similarly, the early SLE group was more likely to have anti-beta 2 glycoprotein-I antibodies, anti-dsDNA, positive Coombs tests, hypocomplementemia, hemolytic anemia, and leukopenia.

Those with SLE-mimicking conditions were more likely to have Raynaud’s phenomenon (22.1% in SLE vs 48.5% in mimicking conditions; P <.001), dysphagia (0.3% vs 6.2%; P <.001), fatigue (28.3% vs 37.0%; P =.02), and symptoms of sicca (4.4% vs 34.4%).

Both the 1997 American College of Rheumatology (ACR) and 2012 Systemic Lupus Collaborating Clinics (SLICC) SLE classification criteria were more common among those with early SLE. Fewer individuals with early SLE were missed by SLICC criteria than by ACR (16.5% vs 33.9%), but ACR performed better in terms of specificity (91.6% vs 82.4%).

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The study authors concluded that “clinical manifestations that could help to distinguish early SLE from mimicking conditions were identified. These findings could aid in earlier SLE diagnosis and provide information for ongoing initiatives to revise SLE classification criteria.”

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Reference

Mosca M, Costenbader KH, Johnson SR, et al. How do patients with newly diagnosed systemic lupus erythematosus present? A multicenter cohort of early systemic lupus erythematosus to inform the development of new classification criteria [published online July 23, 2018]. Arthritis Rheumatol. doi: 10.1002/art.40674