title: Identification of patient subsets among those presumptively diagnosed with, referred, and/or followed up for systemic lupus erythematosus at a large tertiary care center.
abstract: 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 abstracted.
  
  
  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.
  
  
  CONCLUSIONS
  When the ACR 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.
authors.affiliation: The University of Alabama at Birmingham 35294, USA.
authors.forename: J
authors.initials: J
authors.lastname: Calvo-Alén
authors.forename: H M
authors.initials: HM
authors.lastname: Bastian
authors.forename: K V
authors.initials: KV
authors.lastname: Straaton
authors.forename: S L
authors.initials: SL
authors.lastname: Burgard
authors.forename: I S
authors.initials: IS
authors.lastname: Mikhail
authors.forename: G S
authors.initials: GS
authors.lastname: Alarcón
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000175:diagnosis; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000145:classification* / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D013997:Time Factors