title: Previous diagnosis of Sjögren's Syndrome as rheumatoid arthritis or systemic lupus erythematosus.
abstract: 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.
authors.affiliation: Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation.
authors.forename: Astrid
authors.initials: A
authors.lastname: Rasmussen
authors.affiliation: Department of Oral Diagnosis and Radiology, University of Oklahoma College of Dentistry.
authors.forename: Lida
authors.initials: L
authors.lastname: Radfar
authors.affiliation: Department of Oral Pathology, University of Oklahoma College of Dentistry, Oklahoma City, OK.
authors.forename: David
authors.initials: D
authors.lastname: Lewis
authors.affiliation: Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation.
authors.forename: Kiely
authors.initials: K
authors.lastname: Grundahl
authors.affiliation: Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Donald U
authors.initials: DU
authors.lastname: Stone
authors.affiliation: College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
authors.forename: C Erick
authors.initials: CE
authors.lastname: Kaufman
authors.affiliation: Department of Oral Surgery, University of Minnesota School of Dentistry.
authors.forename: Nelson L
authors.initials: NL
authors.lastname: Rhodus
authors.affiliation: Department of Medicine, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Barbara
authors.initials: B
authors.lastname: Segal
authors.affiliation: Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Wallace
authors.affiliation: Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Weisman
authors.affiliation: Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Swamy
authors.initials: S
authors.lastname: Venuturupalli
authors.affiliation: Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation College of Medicine, Department of Medicine, Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center and.
authors.forename: Biji T
authors.initials: BT
authors.lastname: Kurien
authors.affiliation: Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lessard
authors.affiliation: Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation.
authors.forename: Kathy L
authors.initials: KL
authors.lastname: Sivils
authors.affiliation: Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation College of Medicine, Department of Medicine, Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center and Department of Medicine, The Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA Hal-Scofield@omrf.org.
authors.forename: R Hal
authors.initials: RH
authors.lastname: Scofield
mesh_terms: D000368:Aged; D000974:Antibodies, Antinuclear / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012217:Rheumatoid Factor / Q000097:blood; D012859:Sjogren's Syndrome / Q000097:blood / Q000175:diagnosis*
chemical_list: D000974:Antibodies, Antinuclear; D012217:Rheumatoid Factor
keywords: Sjögren’s syndrome; diagnosis; diagnostic delay; differential diagnosis; rheumatoid arthritis; sicca; systemic lupus erythematosus; systemic sclerosis