IDENTIFICATION OF PATIENT SUBSETS AMONG THOSE PRESUMPTIVELY DIAGNOSED WITH, REFERRED, AND/OR FOLLOWED UP FOR SYSTEMIC LUPUS-ERYTHEMATOSUS AT A LARGE TERTIARY CARE CENTER

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 less than or equal to 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, Conclusion, 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.