**2.2 Consider evidence of lupus in every disease**

Physicians should consider lupus as every disease they see, and work backward from that point. Note the following:



#### **Table 1.**

*Approximate prevalence (%) of selected symptoms, signs, and laboratory abnormalities of systemic lupus erythematosus during the course of the disease in the United States [29].*

**7**

*Don't Miss Lupus*

*DOI: http://dx.doi.org/10.5772/intechopen.96892*

patients, and lipid-lowering potential [26].

**3. Common presentations of lupus**

**3.1 Arthropathies**

diagnosed with lupus within in the United States.

frequently painless and often noticed surreptitiously [28].

and dry mouth, may be an indication of lupus (**Table 1**).

should be considered.

in lupus [24]. Although these lesions may be seen in other conditions, lupus

3.Uveitis, typically anterior, is common in lupus [25]. It may occur one time, and may be infectious. Diagnostic possibilities included syphilis, tuberculosis or Lyme disease. If these infections are excluded, then undoubtedly, even if the patient's uveitis is a first-time occurrence, a lupus workup should be initiated.

As with all patients presenting any of the above features, clinicians should initiate confirmatory laboratory workup, including phospholipids, ANA, DNA, ENA, SSA, and SSB, in order to establish a baseline, when a patient exhibits a potential lupus feature at any point. Hypothetically a young patient, between 15 and 20 years of age, may present to a clinic with anterior uveitis. Rather than labeling this as viral, the practitioner should immediately consider a differential diagnosis that includes lupus. Other differential possibilities would include syphilis, tuberculosis, HLA-B27 diseases (including but not limited to psoriatic arthritis), HLA-B27 uveitis, ankylosing spondylitis, reactive arthritis, Crohn's colitis and ulcerative colitis. Regardless of the ultimate diagnosis, the treatment does not change; however, if the patient requires treatment with hydroxychloroquine, early diagnosis may lead to a more favorable outcome. Hydroxychloroquine is paramount. Many clinical trials over decades support its efficacy in prevention of lupus flares, thrombosis in lupus

In addition to the three presentations listed above, mouth sores also occur in lupus, Crohn's disease, Behcet's disease, phospholipid antibody syndrome, tuberculosis, syphilis, sarcoidosis, Sjogren's syndrome, IgG4-related disease, and viral infections [27]. Viral ulcers tend to be painful. Behcet's ulcers generally reveal large, circumscribed, beefy-red borders. Ulcers associated with Crohn's disease are usually shallow painful ulcers, similar to those seen in sarcoidosis. Lupus ulcers are

Additionally, isolated lymphadenopathy does not necessarily have to be hilar or mediastinal; it could be epitrochlear, glandular swelling, lacrimal, parotid, or submandibular. However, the finding, incidental or not, with or without dry eyes

The following represents selected symptoms and abnormalities in patients

Approximately 50% of lupus patients suffer from arthritis [29]. Joint disease, quite often a small joint polyarthritis, typically symmetric, is noted with typical involvement of PIPs, MCPs and wrists, inflammatory in nature; however, this is not erosive, which differentiates it from rheumatoid arthritis [30]. However, the practitioner should keep in mind that the differential diagnosis of IgG4-related disease, lymphomas, Sjogren's, sarcoidosis, or spondyloarthropathies, can also present with a phenotypic appearance of lupus arthritis. The definitive finding of arthritis only seen in lupus would be lupus arthropathy or acute rheumatic fever, which is followed by Jaccoud's arthropathy. Jaccoud's arthropathy is a chronic, non-erosive, reversible (with proper splinting) joint disorder that may occur after repeated bouts of arthritis. This arthropathy is caused by inflammation of the joint capsule and subsequent

in lupus [24]. Although these lesions may be seen in other conditions, lupus should be considered.

3.Uveitis, typically anterior, is common in lupus [25]. It may occur one time, and may be infectious. Diagnostic possibilities included syphilis, tuberculosis or Lyme disease. If these infections are excluded, then undoubtedly, even if the patient's uveitis is a first-time occurrence, a lupus workup should be initiated.

As with all patients presenting any of the above features, clinicians should initiate confirmatory laboratory workup, including phospholipids, ANA, DNA, ENA, SSA, and SSB, in order to establish a baseline, when a patient exhibits a potential lupus feature at any point. Hypothetically a young patient, between 15 and 20 years of age, may present to a clinic with anterior uveitis. Rather than labeling this as viral, the practitioner should immediately consider a differential diagnosis that includes lupus. Other differential possibilities would include syphilis, tuberculosis, HLA-B27 diseases (including but not limited to psoriatic arthritis), HLA-B27 uveitis, ankylosing spondylitis, reactive arthritis, Crohn's colitis and ulcerative colitis. Regardless of the ultimate diagnosis, the treatment does not change; however, if the patient requires treatment with hydroxychloroquine, early diagnosis may lead to a more favorable outcome. Hydroxychloroquine is paramount. Many clinical trials over decades support its efficacy in prevention of lupus flares, thrombosis in lupus patients, and lipid-lowering potential [26].

In addition to the three presentations listed above, mouth sores also occur in lupus, Crohn's disease, Behcet's disease, phospholipid antibody syndrome, tuberculosis, syphilis, sarcoidosis, Sjogren's syndrome, IgG4-related disease, and viral infections [27]. Viral ulcers tend to be painful. Behcet's ulcers generally reveal large, circumscribed, beefy-red borders. Ulcers associated with Crohn's disease are usually shallow painful ulcers, similar to those seen in sarcoidosis. Lupus ulcers are frequently painless and often noticed surreptitiously [28].

Additionally, isolated lymphadenopathy does not necessarily have to be hilar or mediastinal; it could be epitrochlear, glandular swelling, lacrimal, parotid, or submandibular. However, the finding, incidental or not, with or without dry eyes and dry mouth, may be an indication of lupus (**Table 1**).
