ES Poni, HL Diaz, BC Escobar, A Serrano. Manifestaciones Clinicas Tempranas de LES (Early Manifestations of SLE), Medicina Interna (Caracas) 2010; 26 (2); 98 - 107 ( 3/2010 )
Background: The study of early systemic lupus erythematosus (SLE) presentation can optimize its diagnosis and treatment. Methods: The clinical charts of those patients ≥12 year sold complied with ≥ 4 criteria for SLE of the American College of Rheumatology (ACR) were reviewed. The term “early presentation of SLE” corresponded to the first year of evolution of the disease, starting with the date when the first(s) criterion/criteria were reported in the chart. The patients were grouped if they complied with a combination of ≥4, 2-3 or 1 ACR criteria for the classification of SLE through the first year of disease. The impact over the early diagnosis of SLE was estimated according to the early performance of the primary care doctor in ruling out the disease. Results: 115 patients were included. At the end of the first year, 68 patients (59.13%) met <4 ACR criteria vs. 47 (40.86%) who met ≥4 (p=0.05). Patients who met <4 criteria fulfilled ≥4 criteria within the next 10 years (mean= 4.9 years). Of the 68 cases with <4 ACR criteria, 31 (45.58%) met two or three criteria and 37 (54.41%) met one solitary criterion (p=0.46). The most frequent early single onset ACR criterion for SLE was the polyarticular inflammatory syndrome, 26 (70.20%) followed by a group of other single criterion that included cutaneous, hematologic, neurologic, cardiopulmonary, renal, and false-positive VDRL, 11 cases (29.72%) (p=0.01). An early solitary criterion-compared with those patients with ≥2- was associated with a lack of documentation -in the medical chart- of constitutional symptoms, indication of serum antibodies and referral to specialist. Conclusion: Patients with an insufficient quota of ACR criteria for SLE exceeded those with ≥4 positive criteria at the end of the first year of the disease. Patients with a single criterion of presentation compared with those patients who started with ≥2 early criteria- were associated with a delay in the early diagnosis of SLE by at least one year. Key words: ACR criteria for Systemic Lupus Erythematosus; difficult diagnosis; early manifestations of SLE; primary care physician.