Previous Diagnosis of Sjögren's Syndrome As Rheumatoid Arthritis or Systemic Lupus Erythematosus

Astrid Rasmussen¹, Lida Radfar², Kiely Grundahl³, David M. Lewis⁴, Donald U Stone^5,6, C. Erick Kaufman⁷, Daniel J Wallace⁸, Michael H. Weisman⁹, Swamy Venuturupalli¹⁰, Christopher J Lessard¹¹, Biji Kurien¹², Juan-Manuel Anaya¹³, Michael D. Rohrer¹⁴, Raj Gopalakrishnan¹⁵, Glen D Houston¹⁶, James Chodosh¹⁷, Pamela J Hughes¹⁸, Nelson L. Rhodus¹⁹, John Ice¹, Kimberly Hefner²⁰, Jennifer A. Kelly²¹, Kathy L. Sivils¹ and R. Hal Scofield^1,22,23, ¹Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, ²Oral Diagnosis and Radiology Department, University of Oklahoma Health Sciences Center College of Dentistry, Oklahoma City, OK, ³Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma CIty, OK, ⁴College of Dentistry, Department of Oral and Maxillofacial Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, ⁵Department of Ophthalmology, Johns Hopkins University, Riyadh, Saudi Arabia, ⁶Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, ⁷College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, ⁸Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, ⁹Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, ¹⁰Cedars-Sinai Medical Center, West Hollywood, CA, ¹¹Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, ¹²Arthritis and Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK, ¹³Center for Autoimmune Diseases Research (CREA), Universidad del Rosario., Bogota, Colombia, ¹⁴Hard Tissue Research Laboratory, University of Minnesota School of Dentistry, Minneapolis, MN, ¹⁵Diagnostic and Biological Sciences, Division of Oral Pathology, University of Minnesota, Minneapolis, MN, ¹⁶Heartland Pathology, Oklahoma City, OK, ¹⁷Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, ¹⁸Division of Oral and Maxillofacial Surgery, University of Minnesota, Minneapolis, MN, ¹⁹Department of Oral Surgery, University of Minnesota School of Dentistry, Minneapolis, MN, ²⁰Hefner Eye Care and Optical Center, Oklahoma City, OK, ²¹Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, ²²Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, ²³US Department of Veterans Affairs Medical Center, Oklahoma City, OK

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: diagnosis, differential diagnosis, rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), Sjogren's syndrome

Session Information

Date: Sunday, November 8, 2015

Title: Sjögren's Syndrome Poster I: Clinical Insights into Sjögren's Syndrome

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: The diagnosis of Sjögren′s Syndrome (SS) is often difficult and many patients are symptomatic for years with other diagnoses before confirmation of SS. Overlapping clinical and serologic features of SS with other connective tissue disorders, in particular rheumatoid arthritis (RA) and systemic lupus erythematous (SLE), may in part drive the misdiagnoses.

Methods: 1191 subjects with sicca were evaluated in a multi-disciplinary clinic and classified for SS based on the American-European Consensus Criteria. They were interrogated for a past history of suspicion or diagnosis of RA, SLE or SSc and these diseases were confirmed or ruled out by applying the corresponding classification criteria if the patients responded affirmatively.

Results: 531 (44.6%) subjects reported previous diagnosis or suspicion of RA, SLE or SSc; we confirmed the suspected diagnosis in 130, but the remaining 401 (75.5%) did not meet criteria for these diseases. Of those previously diagnosed with another illness, 183 (45.6%) met criteria for primary Sjögren′s syndrome. Rheumatoid factor was present in 31/71 patients with a previous diagnosis of RA compared to 185/830 without a history of RA diagnosis (p<0.0001), while 118/147 with a diagnosis of SLE had positive ANA compared to 621 of 926 without the diagnosis (p=0.012). Age also influenced prior diagnoses: people with suspected RA were older than those without the diagnosis (p<0.0001), while patients with SLE suspicion were younger (p=0.009). Presence of anti-Ro/SSA showed a gradient that was progressively less common in subjects who were pure SS, RA and/or SLE overlap with SS, misdiagnosed RA or SLE, and lowest in non-SS sicca. History of a diagnosis of RA or SLE did not distinguish Sjögren′s syndrome from non-Sjögren’s sicca.

Conclusion: Among subjects classified as Sjögren′s syndrome, the presence of a positive ANA or rheumatoid factor was associated with a previous, apparently erroneous diagnosis of SLE or RA, respectively.

Disclosure: A. Rasmussen, None; L. Radfar, None; K. Grundahl, None; D. M. Lewis, None; D. U. Stone, None; C. E. Kaufman, None; D. J. Wallace, None; M. H. Weisman, None; S. Venuturupalli, None; C. J. Lessard, None; B. Kurien, None; J. M. Anaya, None; M. D. Rohrer, None; R. Gopalakrishnan, None; G. D. Houston, None; J. Chodosh, None; P. J. Hughes, None; N. L. Rhodus, None; J. Ice, None; K. Hefner, None; J. A. Kelly, None; K. L. Sivils, None; R. H. Scofield, None.

To cite this abstract in AMA style:

Rasmussen A, Radfar L, Grundahl K, Lewis DM, Stone DU, Kaufman CE, Wallace DJ, Weisman MH, Venuturupalli S, Lessard CJ, Kurien B, Anaya JM, Rohrer MD, Gopalakrishnan R, Houston GD, Chodosh J, Hughes PJ, Rhodus NL, Ice J, Hefner K, Kelly JA, Sivils KL, Scofield RH. Previous Diagnosis of Sjögren’s Syndrome As Rheumatoid Arthritis or Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/previous-diagnosis-of-sjogrens-syndrome-as-rheumatoid-arthritis-or-systemic-lupus-erythematosus/. Accessed .

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