Many times lupus is accompanied by other autoimmune diseases, and fibromyalgia. The most common overlaps are Sjögren’s Syndrome (80 -85%), Scleroderma (80 –85%), Rheumatoid Arthritis (50%), Myositis (20%), Raynaud’s phenomenon, Fibromyalgia, Antiphospholipid antibody syndrome, Mixed Connective Tissue Disease, Hashimoto’s thyroiditis (hypothyroidism), and Celiac disease.
Sjogren’s Syndrome
Primary: the only autoimmune
disease
Secondary: along with another
autoimmune disease
•Rule out medication-induced dryness
•Other symptoms:
–Vaginal dryness
–Rare systemic manifestations
Sjogren’s Syndrome: ACR Criteria
1.Symptoms of dry eyes
2.Symptoms of dry mouth
3.Positive Shirmer’s or Rose Bengal test (tests for eye dryness)
4. Positive salivary gland biopsy
5. Abnormal salivary gland function on testing
6. Positive Ro and/or La autoantibodies
To be classified as having Sjogren’s syndrome, an individual must either have:
Any 4, including either #4 or #6
OR
Any 3 of the last 4 criteria
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Scleroderma (Systemic Sclerosis)
Inflammatory disease with fibrosis
•Anti-centromere ANA or SCL-70
•Skin tightening
•Severe Raynaud’s phenomenon
•GERD
•Interstitial lung disease
•Pulmonary hypertension
•Renal crisis with severe hypertension
Primary Scleroderma
Limited Scleroderma
C: Calcinosis
R: Raynaud’s
E: Esophageal dysmotility
S: Sclerodactyly -only fingers
T: Telangectasias
Positive anti-centromere antibody
Diffuse Scleroderma
•Tight skin over hands, arms, face, torso, legs
•Esophageal dysmotility
•Pulmonary hypertension
•Scleroderma renal crisis
Positive anti-SCL70 antibody
Scleroderma ACR Criteria
Must have either the Major Criteria OR 2 of 3 Minor Criteria
Major Criteria
Proximal sclerodactyly (proximal to the MCP)
Minor Criteria
Sclerodactyly
Digital pitting scars of fingertips
or
Decreased tissue in finger pad
Bibasilar pulmonary fibrosis
Secondary Scleroderma & Mixed Connective Tissue Disease
(MCTD)
•Overlap of lupus and scleroderma
–Some doctors don’t think that MCTD exists!! They prefer to define patients
as having either SLE or Scleroderma
•Positive RNP antibody
•Puffy hands
•Severe Raynaud’s phenomenon
•Muscle inflammation
*********************************************************************************************************************************************************
Antiphospholipid Syndrome (APS)
Sapporo Criteria: one clinical and one lab
criteria
Clinical Criteria (at least one)
•Thrombosis
–Arterial or Venous
•Pregnancy Loss
–1stTrimester: 3 or more consecutive unexplained spontaneous
abortions
–2ndor 3rdTrimester: 1 unexplained
loss
–Preterm birth (<32 weeks) due to placental problems or severe
preeclampsia
Laboratory criteria (12 weeks apart)
•Anticardiolipin antibody
–Moderate to High IgG and/or IgM
•Anti β2 glycoprotein I antibody
–Moderate to High IgG and/or IgM
•Lupus Anticoagulant
–Prolonged clotting time
–False-positive RPR
*********************************************************************************************************************************************************
Rheumatoid Arthritis: ACR Criteria
Must have 4 for at least 6 weeks
1.Morning stiffness for at least 1 hour
2.Arthritis of at least 3 areas
3.Arthritis of wrists or hands
4.Symmetricarthritis
5.Rheumatoid nodules
6.Positive Rheumatoid factor
7.Xray changes: erosions around joints
********************************************************************************************************************************************************
Fibromyalgia
•With SLE:
–Over 30% of patients with SLE also have FM
–Up to 50% have symptoms of FM, but fewer than 11 tender points.
•It is important to distinguish between FM and SLE symptoms!!
•It is not difficult to discern whether someone has both
disorders
Fibromyalgia: ACR Criteria
Widespread pain:pain in both arms, both legs, and neck or back for 3 months
Tender points 11 of 18 tender points are painful to palpation
Primary: no concomitant autoimmune disease
Secondary: in association with an autoimmune disease
Fibromyalgia Additional Symptoms
•Fatigue
•Poor sleep: rarely feel rested after a full night of sleep
•Irritable bowel syndrome
•Headaches
•Pelvic pain
********************************************************************************************************************************************************
Myositis
Muscle inflammation and damage may also be caused by
certain medications. These are called toxic myopathies. Perhaps the most
common toxic myopathy is caused by statin medications which are frequently
prescribed to lower cholesterol levels. In most cases, the muscle can recover
once the problem medication is identified and stopped.
Symptoms
Symptoms of myositis may include:
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Raynaud’s phenomenon
Raynaud’s phenomenon is a condition of ANS involvement caused
by inflammation of nerves or blood vessels. Blood vessels in your hands and
feet go into spasm and restrict blood flow, usually as a reaction to cold
temperatures, with the tips of the fingers or toes turning red, white, or blue.
Raynaud’s can also cause pain, numbness, or tingling in fingers and/or toes.
People who have Raynaud’s phenomenon are advised to avoid cold conditions when
possible, and may have to wear gloves or mittens when in air-conditioned
surroundings.
This information comes from The Lupus Foundation of America and The John Hopkins Myositis Center
Sjogren’s Syndrome
Primary: the only autoimmune
disease
Secondary: along with another
autoimmune disease
•Rule out medication-induced dryness
•Other symptoms:
–Vaginal dryness
–Rare systemic manifestations
Sjogren’s Syndrome: ACR Criteria
1.Symptoms of dry eyes
2.Symptoms of dry mouth
3.Positive Shirmer’s or Rose Bengal test (tests for eye dryness)
4. Positive salivary gland biopsy
5. Abnormal salivary gland function on testing
6. Positive Ro and/or La autoantibodies
To be classified as having Sjogren’s syndrome, an individual must either have:
Any 4, including either #4 or #6
OR
Any 3 of the last 4 criteria
*********************************************************************************************************************************************************
Scleroderma (Systemic Sclerosis)
Inflammatory disease with fibrosis
•Anti-centromere ANA or SCL-70
•Skin tightening
•Severe Raynaud’s phenomenon
•GERD
•Interstitial lung disease
•Pulmonary hypertension
•Renal crisis with severe hypertension
Primary Scleroderma
Limited Scleroderma
C: Calcinosis
R: Raynaud’s
E: Esophageal dysmotility
S: Sclerodactyly -only fingers
T: Telangectasias
Positive anti-centromere antibody
Diffuse Scleroderma
•Tight skin over hands, arms, face, torso, legs
•Esophageal dysmotility
•Pulmonary hypertension
•Scleroderma renal crisis
Positive anti-SCL70 antibody
Scleroderma ACR Criteria
Must have either the Major Criteria OR 2 of 3 Minor Criteria
Major Criteria
Proximal sclerodactyly (proximal to the MCP)
Minor Criteria
Sclerodactyly
Digital pitting scars of fingertips
or
Decreased tissue in finger pad
Bibasilar pulmonary fibrosis
Secondary Scleroderma & Mixed Connective Tissue Disease
(MCTD)
•Overlap of lupus and scleroderma
–Some doctors don’t think that MCTD exists!! They prefer to define patients
as having either SLE or Scleroderma
•Positive RNP antibody
•Puffy hands
•Severe Raynaud’s phenomenon
•Muscle inflammation
*********************************************************************************************************************************************************
Antiphospholipid Syndrome (APS)
Sapporo Criteria: one clinical and one lab
criteria
Clinical Criteria (at least one)
•Thrombosis
–Arterial or Venous
•Pregnancy Loss
–1stTrimester: 3 or more consecutive unexplained spontaneous
abortions
–2ndor 3rdTrimester: 1 unexplained
loss
–Preterm birth (<32 weeks) due to placental problems or severe
preeclampsia
Laboratory criteria (12 weeks apart)
•Anticardiolipin antibody
–Moderate to High IgG and/or IgM
•Anti β2 glycoprotein I antibody
–Moderate to High IgG and/or IgM
•Lupus Anticoagulant
–Prolonged clotting time
–False-positive RPR
*********************************************************************************************************************************************************
Rheumatoid Arthritis: ACR Criteria
Must have 4 for at least 6 weeks
1.Morning stiffness for at least 1 hour
2.Arthritis of at least 3 areas
3.Arthritis of wrists or hands
4.Symmetricarthritis
5.Rheumatoid nodules
6.Positive Rheumatoid factor
7.Xray changes: erosions around joints
********************************************************************************************************************************************************
Fibromyalgia
•With SLE:
–Over 30% of patients with SLE also have FM
–Up to 50% have symptoms of FM, but fewer than 11 tender points.
•It is important to distinguish between FM and SLE symptoms!!
•It is not difficult to discern whether someone has both
disorders
Fibromyalgia: ACR Criteria
Widespread pain:pain in both arms, both legs, and neck or back for 3 months
Tender points 11 of 18 tender points are painful to palpation
Primary: no concomitant autoimmune disease
Secondary: in association with an autoimmune disease
Fibromyalgia Additional Symptoms
•Fatigue
•Poor sleep: rarely feel rested after a full night of sleep
•Irritable bowel syndrome
•Headaches
•Pelvic pain
********************************************************************************************************************************************************
Myositis
Muscle inflammation and damage may also be caused by
certain medications. These are called toxic myopathies. Perhaps the most
common toxic myopathy is caused by statin medications which are frequently
prescribed to lower cholesterol levels. In most cases, the muscle can recover
once the problem medication is identified and stopped.
Symptoms
Symptoms of myositis may include:
- trouble rising from a chair
- difficulty climbing stairs or lifting arms
- tired feeling after standing or walking
- trouble swallowing or breathing
- muscle pain and soreness that does not resolve after a
few weeks - known elevations in muscle enzymes by blood tests (CPK
or aldolase)
*********************************************************************************************************************************************************
Raynaud’s phenomenon
Raynaud’s phenomenon is a condition of ANS involvement caused
by inflammation of nerves or blood vessels. Blood vessels in your hands and
feet go into spasm and restrict blood flow, usually as a reaction to cold
temperatures, with the tips of the fingers or toes turning red, white, or blue.
Raynaud’s can also cause pain, numbness, or tingling in fingers and/or toes.
People who have Raynaud’s phenomenon are advised to avoid cold conditions when
possible, and may have to wear gloves or mittens when in air-conditioned
surroundings.
This information comes from The Lupus Foundation of America and The John Hopkins Myositis Center