Zusammenfassung
Die frühe Diagnose bei Patienten mit systemischem Lupus Erythematodes (SLE) bleibt eine Herausforderung auch für den erfahrenen Rheumatologen. Grund hierfür ist das vielfältige klinische Erscheinungsbild von nur einzelnen Symptomen bis hin zum Vollbild der Systemerkrankung mit Beteiligung zahlreicher Organe. Zudem ist die Symptomatik wechselhaft je nach Aktivitätszustand. Da in den letzten Jahren keine neuen alltagstauglichen diagnostischen Parameter im Bereich der Laborwerte oder Bildgebung hinzugekommen sind, bleibt die aufmerksame Würdigung anamnestischer Angaben, des körperlichen Untersuchungsbefundes, der schrittweisen Labordiagnostik sowie weiterführender Organdiagnostik der einzige Weg zur Diagnose. Hierbei sind die 1997 revidierten Klassifikationskriterien des ACR eine Hilfe, jedoch im Einzelfall nicht allein ausschlaggebend. Angesichts des potentiell organoder lebensbedrohlichen Verlaufs der Erkrankung ist die interdisziplinäre Kooperation zwischen Hausärzten, Fachärzten und dem internistischen Rheumatologen besonders wichtig.
Summary
Early diagnosis in patients with systemic lupus erythematosus (SLE) remains a challenge even to experienced rheumatologists. This is due to the diversity of presentation with single or multiple manifestations and the variable course. In contrast to the considerable progress in treatment modalities no reliable diagnostic marker has been developed in the last years. So the diagnosis is made largely on clinical grounds with great awareness of anamnestic features, thoroughly performed physical examination supported by laboratory and organspecific tests. The 1997 revised ACR classification criteria are of great value, though they do not satisfy in every single case. With respect to the potentially life or organ threatening course of SLE a good interdisciplinary cooperation of general practitioners and specialists with rheumatologists is of special importance.
References
Aranow C, Ginzler EM (2003) Treatment of constitutional symptoms, skin, joint, serositis, cardiopulmonary, hematologic and central nervous system manifestations. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (eds) Rheumatology. Mosby, Edinburgh London New York Philadelphia St Louis Sydney Toronto, pp 1395–1404
Arbuckle MR, McClain MT, Rubertone MV, Scofield RH, Dennis GJ, James JA et al (2003) Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med 349:1526–1533
Buyon JP, SLE B (2001) Clinical and laboratory features. In: Klippel JH, editor. Primer on the rheumatic diseases. Arthritis Foundation, Atlanta, pp 335–346
Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P et al (1993) Systemic lupus erythematosus: clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. The European Working Party on Systemic Lupus Erythematosus. Medicine (Baltimore) 72:113–124
Cooper GS, Parks CG, Treadwell EL, St Clair EW, Gilkeson GS, Cohen PL et al (2002) Differences by race, sex and age in the clinical and immunologic features of recently diagnosed systemic lupus erythematosus patients in the southeastern United States. Lupus 11:161–167
Dijkstra S, Nieuwenhuys EJ, Swaak AJ (1999) The prognosis and outcome of patients referred to an outpatient clinic for rheumatic diseases characterized by the presence of antinuclear antibodies (ANA). Scand J Rheumatol 28:33–37
Egner W (2000) The use of laboratory tests in the diagnosis of SLE. J Clin Pathol 53:424–432
Ganczarczyk L, Urowitz MB, Gladman DD (1989) “Latent lupus”. J Rheumatol 16:475–478
Gladman DD, Urowitz MB (2003) Clinical features. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (eds) Rheumatology. Mosby, Edinburgh London New York Philadelphia St Louis Sydney Toronto, pp 1359–1379
Gomez-Puerta JA, Martin H, Amigo MC, Aguirre MA, Camps MT, Cuadrado MJ et al (2005) Long-term follow-up in 128 patients with primary antiphospholipid syndrome: do they develop lupus? Medicine (Baltimore) 84:225–230
Haga HJ, Cervera R (1994) Early diagnosis of systemic lupus erythematosus. A challenge for clinicians of different specialties. Tidsskr Nor Laegeforen 114:1409–1411
Haugbro K, Nossent JC, Winkler T, Figenschau Y, Rekvig OP (2004) Anti-dsDNA antibodies and disease classification in antinuclear antibody positive patients: the role of analytical diversity. Ann Rheum Dis 63:386–394
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725
Hopkinson ND, Doherty M, Powell RJ (1994) Clinical features and racespecific incidence/prevalence rates of systemic lupus erythematosus in a geographically complete cohort of patients. Ann Rheum Dis 53:675–680
Isenberg D (2004) Anti-dsDNA antibodies: still a useful criterion for patients with systemic lupus erythematosus? Lupus 13:881–885
Linnik MD, Hu JZ, Heilbrunn KR, Strand V, Hurley FL, Joh T (2005) Relationship between anti-doublestranded DNA antibodies and exacerbation of renal disease in patients with systemic lupus erythematosus. Arthritis Rheum 52:1129–1137
Maddison PJ (2002) Is it SLE? Best Pract Res Clin Rheumatol 16:167–180
Manzi S, Navratil JS, Ruffing MJ, Liu CC, Danchenko N, Nilson SE et al (2004) Measurement of erythrocyte C4d and complement receptor 1 in systemic lupus erythematosus. Arthritis Rheum 50:3596–3604
Ozbek S, Sert M, Paydas S, Soy M (2003) Delay in the diagnosis of SLE: the importance of arthritis/arthralgia as the initial symptom. Acta Med Okayama 57:187–190
Petri M (2003) Systemic lupus erythematosus: an update for clinicians. Int J Adv Rheumatol 1:53–57
Rahman A (2004) Autoantibodies, lupus and the science of sabotage. Rheumatology (Oxford) 43:1326–1336
Riboldi P, Gerosa M, Moroni G, Radice A, Allegri F, Sinico A et al (2005) Anti-DNA antibodies: a diagnostic and prognostic tool for systemic lupus erythematosus? Autoimmunity 38:39–45
Sawalha AH, Harley JB (2004) Antinuclear autoantibodies in systemic lupus erythematosus. Curr Opin Rheumatol 16:534–540
Solomon DH, Shmerling RH, Schur PH, Lew R, Fiskio J, Bates DW (1999) A computer based intervention to reduce unnecessary serologic testing. J Rheumatol 26:2578–2584
Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271–1277
Tan EM, Feltkamp TE, Smolen JS, Butcher B, Dawkins R, Fritzler MJ et al (1997) Range of antinuclear antibodies in “healthy” individuals. Arthritis Rheum 40:1601–1611
Trager J, Ward MM (2001) Mortality and causes of death in systemic lupus erythematosus. Curr Opin Rheumatol 13:345–351
Tucker LB, Menon S, Schaller JG, Isenberg DA (1995) Adult- and childhood-onset systemic lupus erythematosus: a comparison of onset, clinical features, serology, and outcome. Br J Rheumatol 34:866–872
Vila LM, Alarcon GS, McGwin G, Jr, Friedman AW, Baethge BA, Bastian HM et al (2004) Early clinical manifestations, disease activity and damage of systemic lupus erythematosus among two distinct US Hispanic subpopulations. Rheumatology (Oxford) 43:358–363
Walz LeBlanc BA, Gladman DD, Urowitz MB (1994) Serologically active clinically quiescent systemic lupus erythematosus–predictors of clinical flares. J Rheumatol 21:2239–2241
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Gaubitz, M., Schotte, H. Frühdiagnose des systemischen Lupus erythematodes (SLE). Z. Rheumatol. 64, 547–552 (2005). https://doi.org/10.1007/s00393-005-0795-4
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DOI: https://doi.org/10.1007/s00393-005-0795-4