A Comprehensive Approach to Differentiating Systemic Lupus Erythematosus From Other Autoimmune Diseases Presenting...

Area of Science:

• Neuroimmunology
• Rheumatology
• Ophthalmology

Background:

• Systemic lupus erythematosus (SLE) is a complex autoimmune disease with significant morbidity and mortality.
• Early diagnosis of SLE is critical for effective patient management and improved outcomes.
• Ocular manifestations, specifically optic neuritis (ON), are increasingly recognized as potential early indicators of SLE.

Purpose of the Study:

• To systematically review the literature on optic neuritis (ON) as an early diagnostic sign of Systemic Lupus Erythematosus (SLE).
• To investigate the utility of ON in differentiating SLE from other autoimmune neurological conditions, primarily multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD).
• To explore diagnostic markers and imaging findings that aid in distinguishing these conditions.

Main Methods:

• A systematic literature review was conducted, analyzing 23 studies with diverse methodologies (retrospective, cross-sectional, cohort, case reports, reviews).
• Keywords and MeSH terms related to autoimmune diseases, ON, MS, NMOSD, and SLE were used for comprehensive literature search.
• Selected studies were evaluated for their contribution to understanding the diagnostic role of ON in SLE and differential diagnosis.

Main Results:

• SLE-associated ON is rare (1% of SLE patients) but distinctive, often bilateral, severe, and painful, with less visual acuity recovery compared to idiopathic ON or MS.
• Diagnostic challenges exist due to overlapping symptoms with NMOSD and MS; specific antibody profiles (e.g., anti-aquaporin-4 IgG) and MRI findings are crucial for differentiation.
• Unique neuroimaging patterns in SLE patients, alongside dermatological signs, genetic factors, and biomarkers (semaphorins, complement levels), provide diagnostic insights.

Conclusions:

• Integrating clinical presentation, laboratory results (including antibody profiles), and neuroimaging is essential for accurate diagnosis and differentiation of SLE, NMOSD, and MS in cases of ON.
• Optic neuritis holds potential as an early symptom for SLE diagnosis, necessitating further research towards concrete diagnostic criteria.
• Improved diagnostic strategies for SLE-associated ON can lead to faster diagnosis and more effective management of this debilitating autoimmune disease.