Astrid Rasmussen1, Lida Radfar2, David Lewis3, Kiely Grundahl1, Donald U Stone4, C Erick Kaufman5, Nelson L Rhodus6, Barbara Segal7, Daniel J Wallace8, Michael H Weisman8, Swamy Venuturupalli8, Biji T Kurien9, Christopher J Lessard1, Kathy L Sivils1, R Hal Scofield10. 1. Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation. 2. Department of Oral Diagnosis and Radiology, University of Oklahoma College of Dentistry. 3. Department of Oral Pathology, University of Oklahoma College of Dentistry, Oklahoma City, OK. 4. Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia. 5. College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK. 6. Department of Oral Surgery, University of Minnesota School of Dentistry. 7. Department of Medicine, Hennepin County Medical Center, Minneapolis, MN. 8. Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA. 9. Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation College of Medicine, Department of Medicine, Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center and. 10. Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation College of Medicine, Department of Medicine, Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center and Department of Medicine, The Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA Hal-Scofield@omrf.org.
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. Published by Oxford University Press on behalf of the British Society for Rheumatology 2016. This work is written by US Government employees and is in the public domain in the United States.
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. Published by Oxford University Press on behalf of the British Society for Rheumatology 2016. This work is written by US Government employees and is in the public domain in the United States.
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