Review Question - QID 105978

This patient is most likely experiencing systemic lupus erythematosis (SLE). SLE immunologic labs are often positive for anti-ds-DNA (very specific to SLE), anti-Sm antibody (very specific, but not sensitive to SLE), and occasionally positive for anti-Ro antibodies.

SLE is a multi-system, autoimmune disorder that is often characterized by polyclonal activation of B cells that results in the production of anti-DNA antibodies. Hydralazine and procainamide are two drugs that are often implicated in causing an SLE-like reaction. Symptoms classically include fever, anorexia, weight loss, arthralgias, and myalgias. Physical examination often shows a malar rash and/or oral ulcers. Treatment often involves NSAIDs and steroids in addition to avoidance of sunlight.

Gibson et al. discuss the antibody testing for systemic lupus erythematosus (SLE). Although antibody testing is a crucial part of diagnosing SLE, it should not be used in isolation as a means of diagnosing SLE. The most commonly used screening test for SLE is the antinuclear antibody (ANA) test. The presence of anti-DNA, anti-Sm, and antiphospholipid antibodies is more specific for diagnosing SLE.

Aviles et al. report on the epidemiological characteristics of patients with cutaneous lupus erythematosus (CLE). Since lupus often extends into the clinical spectrum of cutaneous manifestations, it is important to understand the epidemiological and immunological characteristics of this subpopulation. 101 patients were observed, and the mean age at diagnosis was 40 years and 84% were women. Patients with acute forms were positive for antinuclear, anti-DNA, anti-smooth muscle, and anti-RNP (ribonucleoprotein) antibodies. Oral immunosuppressants were often needed to control the disease in a large proportion of patients.

Figure A demonstrates aphthous oral ulcers which are often seen in patients with SLE. Illustration A depicts the classic malar rash of systemic lupus erythematosus. Illustration B is an overview image representing the typical symptoms often seen with SLE. Illustration C demonstrates hard palate oral ulcers of SLE.

Incorrect Answers:
Answer 2: Anti-La antibodies are biomarkers often seen in Sjogren's syndrome.
Answer 3: Anti-centromere antibodies are often seen in association with scleroderma (CREST syndrome).
Answer 4: Anti-cardiolipin antibodies can be found in SLE, but are not as common as anti-ds-DNA antibodies. Anti-cardiolipin can also be found in several other diseases, including syphilis, antiphospholipid syndrome (can result in spontaneous abortions), and Behçet's syndrome.
Answer 5: Anti-ganglioside antibodies are most often seen in certain forms of Guillain-Barré syndrome.