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DIFFERENTIATING TESTS
Joint
clinically.
Patients with SLE frequently present
with an inflammatory arthritis with a similar pattern to RA, although it tends to be less symmetrical. Antiphospholipid syndrome
Characterised by the occurrence of Antiphospholipid
venous or arterial thrombosis or recurrent fetal loss in the presence of antiphospholipid antibodies.
antibodies: anticardiolipin antibodies IgG or IgM present in moderate or high levels on 2 occasions at least 6 weeks apart and lupus anticoagulant detected on 2 occasions at least 6 weeks apart. These antibodies may also be positive in SLE. of patients with antiphospholipid syndrome are b-glycoprotein positive. [61] Disease Research Laboratory (VDRL) test: falsepositive result.
10%
Venereal
Systemic sclerosis
almost all patients with systemic sclerosis, being the initial symptom in about 70% of patients. Patients with SLE often have Raynaud's phenomenon as well, but these tend not to ulcerate compared to patients with systemic sclerosis.
Patients with systemic sclerosis have
centromere antibodies (limited cutaneous systemic sclerosis) or anti-topoisomerase 1 (Scl-70) antibodies (diffuse cutaneous systemic sclerosis).
characteristic sclerodactyly calcinosis, not present in SLE. Mixed connective tissue disease (MCTD)
MCTD
and
Auto-antibodies: positive anti-
is characterised by a combination of manifestations similar to those in SLE, systemic sclerosis, and myositis. Difficult to differentiate clinically.
arthritis characterised by seronegative chronic polyarthritis in association with a systemic inflammatory illness, which manifests as symptoms similar to those of SLE.
The fever in adult Still's disease
ferritin has been reported in most patients. Ferritin should therefore be checked in patients presenting with such symptoms and, if elevated, lead to a suspicion of adult Still's disease. RA and joint erosions and fusion on x-ray may occur, unlike in SLE.
usually occurs once or twice daily with marked temperature elevation and normal temperature in between.
The rash is often only seen during
febrile periods and is a salmon-coloured macular or maculopapular non-pruritic lesion. Lyme disease
May
be
difficult
to
distinguish
clinically.
History of possible erythema migrans
positive.
Although the presence of ANA
or exposure to ticks.
is common, the presence of dsDNA and Smith antibodies are not. to distinguish
Serum
HIV
May
be
difficult
clinically.
History of exposure to risk factors for
positive.
Although the presence of ANA
HIV.
is common, the presence of dsDNA and Smith antibodies are not. be difficult to distinguish
CMV serology is positive for
CMV
May
clinically.
May be asymptomatic.
infection.
Although the presence of ANA
is common, the presence of dsDNA and Smith antibodies are not. Infectious mononucleosis
May
be
difficult
to
distinguish
clinically.
example, monospot.
Although the presence of ANA
is common, the presence of dsDNA and Smith antibodies are not. Haematological malignancy
SLE may be difficult to distinguish Bone marrow, other histology
clinically
from
haematological
malignancy.
the diagnosis.
Auto-antibodies
will
be
negative. Glomerulonephritis
Difficult to differentiate clinically if Antibodies for dsDNA may be
no other symptoms or signs associated with SLE are present, for example, Raynaud's, rash. Chronic fatigue syndrome
No other signs that are typically
biopsy diagnosis.
may
aid
in
Auto-antibodies
will
be
negative.
May
be difficult to differentiate clinically as seizures can be a feature of SLE. However, no other signs that are typically associated with SLE (e.g., Raynaud's, rash) will be present.
EEG
will
be
will
be
negative.
steroidal (NSAIDs).
anti-inflammatory
drugs
Depression
will
be
negative.