The peculiarities of differential diagnosis of systemic lupus erythematosus.

The peculiarities of differential diagnosis of systemic lupus erythematosus.

Prof. L. Zhuravlyova, PHD N. Alexandrova, PHD I. Letik.

Systemic lupus erythematosus is one of the most severe systemic connective tissue diseases. Atypical variants of the disease manifestation and its course, multiple syndromes, resistance to aggressive treatments and a wide range of comorbidities – all this makes it difficult to perform differential diagnosis and manage these patients. The article presents the diagnostic criteria for systemic lupus erythematosus, the main symptoms and syndromes, the spectrum of comorbidity, given assessment of the impact of the therapy on the clinical picture and the main diseases that should be differentiated, description of a laboratory diagnostic algorithm for the differential diagnosis of systemic connective tissue diseases.

Key words: systemic lupus erythematosus, diagnostic algorithm, differential diagnosis.

Zhuravlyova LV, Alexandrova NA, Letik II. [The peculiarities of differential diagnosis of systemic lupus erythematosus]. Shidnoevr. z. vnutr. simejnoi med. 2015;1:24-34. Russian.

http://dx.doi.org/10.15407/internalmed2015.01.025

Download.PDF

1. Aleksandrova EN, Novikov AA, Nasonov EL. Sovremennye standarty laboratornoi diagnostiki revmaticheskikh zabolevanii. [Modern standarts of laboratory diagnostics of rheumatological diseases]. 2 ed. M.; 2012. 61 p. Russian

2. Asherson RA. Varianty antifosfolipidnogo sindroma: neskolko novykh kontseptsii. [Variants of antiphospholipid syndrome: several new conceptions]. Terapevticheskii arkhiv. 2008; (5): 83—85. Russian

3. Bazarnyi VV, Afonkina NS. K voprosu o klinicheskoi znachimosti LE- fenomena. [To the question of clinical significance of LE-phenomenon]. Klinicheskaia i laboratornaia diagnostika. 2006; (5): 43. Russian

4. Eritsian EE. Novyi podkhod v diagnostike sistemnoi krasnoi volchanki: immunoaggliutinatsiia kolloidnogo zolota. [New approaches to diagnostics of systemic lupus erythematosus: immunoagglutination of colloid aurum]. Klinicheskaia i laboratornaia diagnostika. 2011; (7): 39—41. Russian

5. Ivanova MM., author. Diffuznye bolezni soedinitelnoi tkani. [Diffuse diseases of connective tissue]. M.: Meditsina; 2004. 253 p. Russian

6. Nasonov EL, editor. Klinicheskie rekomendatsii po revmatologii [Clinical guidelines for Rheumatology]. 2-e izd. — M.: GEOTAR-Media; 2010. 429—481. Russian

7. Kliukvina NG, Nasonov EL. Osobennosti klinicheskikh i laboratornykh proiavlenii sistemnoi krasnoi volchanki. [Features of clinical and laboratory signs of systemic lupus erythematosus]. Sovremennaia revmatologiia. 12 (4): 40—48. Russian

8. Kliukvina NG. Sistemnaia krasnaia volchanka. [Systemic lupus erythematosus]. Sovremennaia revmatologiia. 11 (4), 11: 25—30. Russian

9. Lazareva NM, Lapin SV, Mazing AV. Optimizatsiia kompleksa serologicheskikh metodov diagnostiki sistemnykh zabolevanii soedinitelnoi tkani. [Optimization of complex of serological methods of diagnostics of systemic diseases of connective tissue]. Klinicheskaia i laboratornaia diagnostika. 2011; (12): 12—17. Russian

10. Lapin SV, Totolian AA, authors. Immunobiologicheskaia laboratornaia diagnostika revmaticheskikh zabolevanii. [Immunobiological laboratory diagnostics of rheumatic diseases] In: Posobie dlia vrachei. [Educational tutorial for doctors]. SPb.; 2006. Russian

11. Nasonov EL, Aleksandrova EN. Sovremennye tekhnologii i perspektivy laboratornoi diagnostiki revmaticheskikh zabolevanii. [Modern technologies and perspectives of laboratory diagnostics of rheumatic diseases]. Terapevticheskii arkhiv. 2010; (5): 5—9. Russian

12. Popkova TV, Lisitsyna TA. Rekomendatsii po vedeniiu bolnykh sistemnoi krasnoi volchankoi v klinicheskoi praktike (po materialam rekomendatsii Evropeiskoi antirevmaticheskoi ligi —EULAR). [Recommendations for care about patients with systemic lupus erythematosus in clinical practice (by materials of recommendations of European antirheumatic society]. Sovremennaia revmatologiia. 2011; (1): 4—12. Russian

13. Skriabina EN, Magdeeva NA, Nam IF. Sistemnaia krasnaia volchanka ili volchanochnopodobnaia «maska» vich-infektsii. [Systemic lupus erythematosus or lupus like mask of AIDS?]. Saratovskii nauchno- meditsinskii zhurnal. 2009; 5 (3): 444—446. Russian

14. Sozina AV, Ilivanova EP, Shulman AM. Kliniko-diagnosticheskoe znachenie vyiavleniia antinuklearnogo faktora, antitel k dvuspiralnoi DNK i kardiolipinu u bolnykh sistemnoi krasnoi volchankoi. [Clinical and laboratory significance of revealing of antinuclear factor, antibodies to two-spirale DNA and to cardiolipin in patients with systemic lupus erythematosus]. Klinicheskaia i laboratornaia diagnostika. 2008; (5): 44—46. Russian

15. Sterling DV, editor. Sekrety revmatologii. [Secrets of rheumatology]. M.: Binom. (SPb.): Nevskii dialekt. 2001. 767 p.

16. Abraham S, Begum S, Isenberg D, authors; Abraham S, editor. [Hepatic manifestations of autoimmune rheumatic diseases]. In: Annals of the Rheumatic Diseases. 2004; 63: 123—129. Russian

17. Barber C, Gold WL, Fortin PR. [Infections in the lupus patient: perspectives on prevention] Current Opinion in Rheumatology. 2011; 23(4): 358— 365. English http://dx.doi.org/10.1097/BOR.0b013e3283476cd8

18. Bertsias G, Ioannidis J, Boletis J. [EULAR recommendations for the management of systemic lupus erythematosus. Report of a task force of the EULAR Standing Committee for International Clinical Studies including Therapeutics]. Annals of the Rheumatic Diseases. 2008; 67: 195—205. English http://dx.doi.org/10.1136/ard.2007.070367

19. Bertsias G, Ioannidis J, Aringer M. [EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs]. Annals of the Rheumatic Diseases. 2010; 69: 2074—2082. English http://dx.doi.org/10.1136/ard.2010.130476

20. Cervera R, Piette JC, Font I. [Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1000 patients]. Arthritis and Rheumatology. 2002; 46: 1019—1025. English http://dx.doi.org/10.1002/art.10187

21. Dvorkina O, Ginzler EM, authors. Lahita R, editor. [Corticosteroid and nonsteroid anti-inflammatory drug use in systemic lupus erythematosus]. Systemic lupus erythematosus. 5th ed. Elsevier. 2011; 1045—1060. English

22. Mosca M, Tani C, Aringer M. [European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies]. Annals of the Rheumatic Diseases. 2010; 69: 1269—1274. English http://dx.doi.org/10.1136/ard.2009.117200

23. Nguyen H, Niharika K. [Intestinal pseudo-obstruction as a presenting manifestation of systemic lupus erythematosus]. Southern Medical Journal. 2004; 97: 86—89. English

24. Pasoto SG, Borba EF, Bonfa E. [Lupus pleuritis: a relevant factor for pulmonary tuberculosis]. Lupus. 2010; 19: 1585—1590. English http://dx.doi.org/10.1177/0961203310375269

25. Peponis V, Kyttaris VC, Tyradellis C. [Ocular manifestations of systemic lupus erythematosus: a clinical review]. Lupus. 2006; 15: 3—12. English http://dx.doi.org/10.1191/0961203306lu2250rr

26. Petri M, Orbai AM, Alarcon G. [Derivation and validation of the Systemic Lupus International Collaborating Clinics Classification Criteria for systemic lupus erythematosus]. Rheumatology. 2012; 64(8): 2677—86. English

27. Rahman P, Gladman DD, Urowitz MB. [Early damage as measured by the SLICC/ACR damage index is a predictor of mortality in systemic lupus erythematosus]. Lupus. 2001; 10: 93—96. English http://dx.doi.org/10.1191/096120301670679959

28. Tucker LB. [Making the diagnosis of systemic lupus erythematosus in children and adolescents]. Lupus. 2007; 16: 546—549. English http://dx.doi.org/10.1177/0961203307078068

29. Weber M, Hayem G, Meyer O. [The Sapporo criteria for antiphospholipid syndrome]. Arthritis and Rheumatology. 2001; (44): 1965—1966. English http://dx.doi.org/10.1002/1529-0131(200108)44:8<1965::AID-ART338>3.0.CO;2-9

30. Werth VP. [Clinical manifestations of cutaneous lupus erythematosus]. Autoimmunity Reviews. 2005; (4): 296—302. English http://dx.doi.org/10.1016/j.autrev.2005.01.003