Previous diagnosis of Sjögren's Syndrome as rheumatoid arthritis or systemic lupus erythematosus

Astrid Rasmussen, Lida Radfar, David Lewis, Kiely Grundahl, Donald U. Stone, C. Erick Kaufman, Nelson L. Rhodus, Barbara Segal, Daniel J. Wallace, Michael H. Weisman, Swamy Venuturupalli, Biji T. Kurien, Christopher J. Lessard, Kathy L. Sivils, R. Hal Scofield

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective. The diagnosis of SS is often difficult and many patients are symptomatic for years with other diagnoses before confirmation of SS. Our aim was to determine whether overlapping clinical and serologic features with RA and SLE may in part drive the misdiagnoses. Methods. A total of 1175 sicca patients were evaluated in a multidisciplinary clinic and classified as having SS based on the American-European Consensus Group Criteria. They were interrogated for a past history of suspicion or diagnosis of RA, SLE or SSc. These diseases were confirmed or ruled out by applying the corresponding classification criteria if the patients responded affirmatively. Results. Of these, 524 (44.6%) subjects reported previous diagnosis or suspicion of RA, SLE or SSc, which was confirmed in 130 (24.8%) but excluded in 394 (75.2%) subjects. Of those previously diagnosed with another illness, 183 (34.9%) met the criteria for primary SS. RF was present in 70/191 patients with previous diagnosis of RA compared with 445/845 without a prior RA diagnosis (P = 3.38E-05), while 128/ 146 with a diagnosis of SLE had positive ANA compared with 622/881 without the diagnosis (P = 8.77E- 06). Age also influenced former diagnoses: people with suspected RA were older than those without the diagnosis (P = 5.89E-06), while patients with SLE suspicion were younger (P = 0.0003). Interestingly, the previous diagnoses did not significantly delay a final classification of SS. Conclusion. Among subjects classified as SS, the presence of a positive ANA or RF was associated with a previous, apparently erroneous diagnosis of SLE or RA, respectively.

Original languageEnglish (US)
Article numberkew023
Pages (from-to)1195-1201
Number of pages7
JournalRheumatology (United Kingdom)
Volume55
Issue number7
DOIs
StatePublished - Jul 1 2016

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Systemic Lupus Erythematosus
Rheumatoid Arthritis
Diagnostic Errors

Keywords

  • Diagnosis
  • Diagnostic delay
  • Differential diagnosis
  • Rheumatoid arthritis
  • Sicca
  • Sjögren's syndrome
  • Systemic lupus erythematosus
  • Systemic sclerosis

Cite this

Rasmussen, A., Radfar, L., Lewis, D., Grundahl, K., Stone, D. U., Kaufman, C. E., ... Hal Scofield, R. (2016). Previous diagnosis of Sjögren's Syndrome as rheumatoid arthritis or systemic lupus erythematosus. Rheumatology (United Kingdom), 55(7), 1195-1201. [kew023]. https://doi.org/10.1093/rheumatology/kew023

Previous diagnosis of Sjögren's Syndrome as rheumatoid arthritis or systemic lupus erythematosus. / Rasmussen, Astrid; Radfar, Lida; Lewis, David; Grundahl, Kiely; Stone, Donald U.; Kaufman, C. Erick; Rhodus, Nelson L.; Segal, Barbara; Wallace, Daniel J.; Weisman, Michael H.; Venuturupalli, Swamy; Kurien, Biji T.; Lessard, Christopher J.; Sivils, Kathy L.; Hal Scofield, R.

In: Rheumatology (United Kingdom), Vol. 55, No. 7, kew023, 01.07.2016, p. 1195-1201.

Research output: Contribution to journalArticle

Rasmussen, A, Radfar, L, Lewis, D, Grundahl, K, Stone, DU, Kaufman, CE, Rhodus, NL, Segal, B, Wallace, DJ, Weisman, MH, Venuturupalli, S, Kurien, BT, Lessard, CJ, Sivils, KL & Hal Scofield, R 2016, 'Previous diagnosis of Sjögren's Syndrome as rheumatoid arthritis or systemic lupus erythematosus', Rheumatology (United Kingdom), vol. 55, no. 7, kew023, pp. 1195-1201. https://doi.org/10.1093/rheumatology/kew023
Rasmussen, Astrid ; Radfar, Lida ; Lewis, David ; Grundahl, Kiely ; Stone, Donald U. ; Kaufman, C. Erick ; Rhodus, Nelson L. ; Segal, Barbara ; Wallace, Daniel J. ; Weisman, Michael H. ; Venuturupalli, Swamy ; Kurien, Biji T. ; Lessard, Christopher J. ; Sivils, Kathy L. ; Hal Scofield, R. / Previous diagnosis of Sjögren's Syndrome as rheumatoid arthritis or systemic lupus erythematosus. In: Rheumatology (United Kingdom). 2016 ; Vol. 55, No. 7. pp. 1195-1201.
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abstract = "Objective. The diagnosis of SS is often difficult and many patients are symptomatic for years with other diagnoses before confirmation of SS. Our aim was to determine whether overlapping clinical and serologic features with RA and SLE may in part drive the misdiagnoses. Methods. A total of 1175 sicca patients were evaluated in a multidisciplinary clinic and classified as having SS based on the American-European Consensus Group Criteria. They were interrogated for a past history of suspicion or diagnosis of RA, SLE or SSc. These diseases were confirmed or ruled out by applying the corresponding classification criteria if the patients responded affirmatively. Results. Of these, 524 (44.6{\%}) subjects reported previous diagnosis or suspicion of RA, SLE or SSc, which was confirmed in 130 (24.8{\%}) but excluded in 394 (75.2{\%}) subjects. Of those previously diagnosed with another illness, 183 (34.9{\%}) met the criteria for primary SS. RF was present in 70/191 patients with previous diagnosis of RA compared with 445/845 without a prior RA diagnosis (P = 3.38E-05), while 128/ 146 with a diagnosis of SLE had positive ANA compared with 622/881 without the diagnosis (P = 8.77E- 06). Age also influenced former diagnoses: people with suspected RA were older than those without the diagnosis (P = 5.89E-06), while patients with SLE suspicion were younger (P = 0.0003). Interestingly, the previous diagnoses did not significantly delay a final classification of SS. Conclusion. Among subjects classified as SS, the presence of a positive ANA or RF was associated with a previous, apparently erroneous diagnosis of SLE or RA, respectively.",
keywords = "Diagnosis, Diagnostic delay, Differential diagnosis, Rheumatoid arthritis, Sicca, Sj{\"o}gren's syndrome, Systemic lupus erythematosus, Systemic sclerosis",
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T1 - Previous diagnosis of Sjögren's Syndrome as rheumatoid arthritis or systemic lupus erythematosus

AU - Rasmussen, Astrid

AU - Radfar, Lida

AU - Lewis, David

AU - Grundahl, Kiely

AU - Stone, Donald U.

AU - Kaufman, C. Erick

AU - Rhodus, Nelson L.

AU - Segal, Barbara

AU - Wallace, Daniel J.

AU - Weisman, Michael H.

AU - Venuturupalli, Swamy

AU - Kurien, Biji T.

AU - Lessard, Christopher J.

AU - Sivils, Kathy L.

AU - Hal Scofield, R.

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Objective. The diagnosis of SS is often difficult and many patients are symptomatic for years with other diagnoses before confirmation of SS. Our aim was to determine whether overlapping clinical and serologic features with RA and SLE may in part drive the misdiagnoses. Methods. A total of 1175 sicca patients were evaluated in a multidisciplinary clinic and classified as having SS based on the American-European Consensus Group Criteria. They were interrogated for a past history of suspicion or diagnosis of RA, SLE or SSc. These diseases were confirmed or ruled out by applying the corresponding classification criteria if the patients responded affirmatively. Results. Of these, 524 (44.6%) subjects reported previous diagnosis or suspicion of RA, SLE or SSc, which was confirmed in 130 (24.8%) but excluded in 394 (75.2%) subjects. Of those previously diagnosed with another illness, 183 (34.9%) met the criteria for primary SS. RF was present in 70/191 patients with previous diagnosis of RA compared with 445/845 without a prior RA diagnosis (P = 3.38E-05), while 128/ 146 with a diagnosis of SLE had positive ANA compared with 622/881 without the diagnosis (P = 8.77E- 06). Age also influenced former diagnoses: people with suspected RA were older than those without the diagnosis (P = 5.89E-06), while patients with SLE suspicion were younger (P = 0.0003). Interestingly, the previous diagnoses did not significantly delay a final classification of SS. Conclusion. Among subjects classified as SS, the presence of a positive ANA or RF was associated with a previous, apparently erroneous diagnosis of SLE or RA, respectively.

AB - Objective. The diagnosis of SS is often difficult and many patients are symptomatic for years with other diagnoses before confirmation of SS. Our aim was to determine whether overlapping clinical and serologic features with RA and SLE may in part drive the misdiagnoses. Methods. A total of 1175 sicca patients were evaluated in a multidisciplinary clinic and classified as having SS based on the American-European Consensus Group Criteria. They were interrogated for a past history of suspicion or diagnosis of RA, SLE or SSc. These diseases were confirmed or ruled out by applying the corresponding classification criteria if the patients responded affirmatively. Results. Of these, 524 (44.6%) subjects reported previous diagnosis or suspicion of RA, SLE or SSc, which was confirmed in 130 (24.8%) but excluded in 394 (75.2%) subjects. Of those previously diagnosed with another illness, 183 (34.9%) met the criteria for primary SS. RF was present in 70/191 patients with previous diagnosis of RA compared with 445/845 without a prior RA diagnosis (P = 3.38E-05), while 128/ 146 with a diagnosis of SLE had positive ANA compared with 622/881 without the diagnosis (P = 8.77E- 06). Age also influenced former diagnoses: people with suspected RA were older than those without the diagnosis (P = 5.89E-06), while patients with SLE suspicion were younger (P = 0.0003). Interestingly, the previous diagnoses did not significantly delay a final classification of SS. Conclusion. Among subjects classified as SS, the presence of a positive ANA or RF was associated with a previous, apparently erroneous diagnosis of SLE or RA, respectively.

KW - Diagnosis

KW - Diagnostic delay

KW - Differential diagnosis

KW - Rheumatoid arthritis

KW - Sicca

KW - Sjögren's syndrome

KW - Systemic lupus erythematosus

KW - Systemic sclerosis

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