Previous diagnosis of Sjögren's Syndrome as rheumatoid arthritis or systemic lupus erythematosus

• Published in: Rheumatology (Oxford, England) Vol. 55; no. 7; pp. 1195 - 1201
• Main Authors: Rasmussen, Astrid, Radfar, Lida, Lewis, David, Grundahl, Kiely, Stone, Donald U, Kaufman, C Erick, Rhodus, Nelson L, Segal, Barbara, Wallace, Daniel J, Weisman, Michael H, Venuturupalli, Swamy, Kurien, Biji T, Lessard, Christopher J, Sivils, Kathy L, Scofield, R Hal
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.07.2016
• Subjects: Aged; Antibodies, Antinuclear - blood; Arthritis, Rheumatoid - diagnosis; Clinical Science; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Lupus Erythematosus, Systemic - diagnosis; Male; Middle Aged; Rheumatoid Factor - blood; Sjogren's Syndrome - blood; Sjogren's Syndrome - diagnosis; differential diagnosis; systemic lupus erythematosus; diagnostic delay; systemic sclerosis; Sjögren’s syndrome; diagnosis; rheumatoid arthritis; sicca
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kew023

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. 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. 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. 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.