Identification of patient subsets among those presumptively diagnosed with, referred, and/or followed up for SLE at a large tertiary care center

OBJECTIVE. To identify different subsets of patients from a large
tertiary care center who were presumptively referred for
and/or diagnosed with systemic lupus erythematosus (SLE) (or
followed up).

METHODS. All patients who were referred,
followed up, and/or diagnosed with SLE at our center, who had
disease duration of < or = 5 years, and who resided in
Alabama, were identified and their charts reviewed and

RESULTS. Abstracted data were reviewed by 3
rheumatologists, and patients were assigned to 1 of 3
categories: 1) SLE by the American College of Rheumatology
(ACR; formerly, the American Rheumatism Association) criteria,
2) clinical SLE but not meeting 4 of the ACR criteria, or 3)
fibromyalgia-like manifestations with antinuclear antibody
(ANA) positivity. There were 90 patients in the first group
(criteria), 22 in the second group (clinical), and 37 in the
third group (fibromyalgia-like). Patients in all 3 groups were
predominantly women. Only 5% of the fibromyalgia-like group
were African-American, compared with 55-65% for the other 2
groups. Organ system involvement occurred with comparable
frequency in the first 2 groups, but mucocutaneous and
hematologic abnormalities were more frequent in the criteria
group; in contrast, the patients with fibromyalgia-like
symptoms primarily presented with arthralgias/myalgias,
fatigue, depression, and sleep disturbances, as well as
mucocutaneous manifestations.

criteria for SLE are used to determine eligibility for lupus
studies, a group of patients with clinically unequivocal SLE
are excluded. A group of patients with fibromyalgia-like
manifestations, who test positive for ANA and differ
clinically and sociodemographically from the patients in the
other 2 groups, very likely do not belong within the spectrum
of SLE.

Calvo-Alen J, Bastian HM, Straaton KV, Burgard SL, Mikhail IS,
Alarcon GS

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