DIAGNOSIS BANDING

CONDITION Rheumatoid arthritis (RA)

May

DIFFERENTIATING SIGNS/SYMPTOMS be difficult to differentiate

DIFFERENTIATING TESTS
Joint

clinically.
Patients with SLE frequently present

x-rays demonstrate symmetrical, erosive arthritis.

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

Raynaud's phenomenon is present in

Auto-antibodies: positive anti-

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.

RNP antibodies are specific to MCTD.

Patients with MCTD tend to

lack other antibodies such as anti-Sm, anti-Ro, anti-La, and

anti-dsDNA. Adult Still's disease

A variant of juvenile rheumatoid Elevated

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

Joint symptoms are similar to

febrile periods and is a salmon-coloured macular or maculopapular non-pruritic lesion. Lyme disease
May

be

difficult

to

distinguish

Lyme-specific IgM and IgG are

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

HIV ELISA test is

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

Positive agglutination test, for

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

or imaging tests may distinguish

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

positive if SLE is the cause.

Renal

biopsy diagnosis.

may

aid

in

Auto-antibodies

will

be

associated with SLE (e.g., Raynaud's, rash) will be present

negative.

Generalised tonic-clonic seizures

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 demonstrate epileptiform activity. lesion.

Brain MRI may demonstrate a Auto-antibodies

will

be

negative in epilepsy. Fibromyalgia

Poorly

localised symmetrical musculoskeletal pain with no diurnal variation.

Poorly responsive to analgesics/non-

Diagnosis is typically clinical. Auto-antibodies

will

be

negative.

steroidal (NSAIDs).

anti-inflammatory

drugs

May co-exist with SLE. Positive typical tender points.

Depression

Typically no systemic manifestations

Diagnosis is typically clinical. Auto-antibodies

(e.g., rash) unless co-exists with SLE.

will

be

negative.