Table 1.
Autoimmune serology assessment for possible rheumatic disease in emergency settings
| Symptom | Positive test result | Disease |
|---|---|---|
| Airway problems | ||
| Hemoptysis | Anti-dsDNA, other lupus serologies | Alveolar hemorrhage in SLE |
| Airflow obstruction | Anti-CCP, RF | Cricoarytenoid arthritis in rheumatoid arthritis (RA) |
| Mucopurulent rhinorrhea; subglottic stenosis; hypopharyngeal ulcerations | Anti-neutrophil cytoplasmic antibodies (ANCA, MPO or PR3) | Wegener’s granulomatosis |
| Stridor, laryngotracheal strictures | Anti-type II collagen | Relapsing polychondritis |
| Acute pneumonitis | Anti-dsDNA, other lupus serologies | SLE |
| Pulmonary–renal problems | ||
| Pulmonary hemorrhage and acute renal failure | Anti-GBM, MPO-ANCA, PR3-ANCA | Goodpasture’s syndrome; systemic vasculitis |
| Neuropsychiatric problems | ||
| Encephalopathy, psychosis, focal central nervous system disease | Anti-N-methyl-d-aspartate receptor (NMDA-R), anti-ribosomal P antibodies, antiphospholipid antibodies | Neuropsychiatric SLE, antiphospholipid syndrome |
| Weakness, paralysis, bilateral sensory deficit, impaired sphincter control | Lupus serologies | Transverse myelitis in SLE |
| Seizures | Anti-dsDNA, other lupus serologies | Lupus cerebritis |
| Thromboembolic problems | ||
| DVT, pulmonary thromboembolism, fetal loss, retinal artery occlusion | Anti-phospholipid antibodies | Antiphospholipid syndrome |
| Neuromuscular problems | ||
| Progressive symmetric muscle weakness; dysphagia; dysphonia | Anti-Jo-1, other myositis-specific autoantibodies | Dermatomyositis, polymyositis |
| Unusual weakness and hypokalemia | Anti-Ro/SSA; anti-La/SSB | Sjogren’s syndrome hypokalemic paralysis |
| Cardiac problems | ||
| Pleuritic or positional chest pain, dyspnea, tachycardia | Anti-dsDNA, other lupus serologies, Anti-phospholipid antibodies | SLE pleuro-pericarditis, pericardial tamponade |
| Congenital heart block; neonatal carditis | Anti-Ro/SSA; anti-La/SSB | Neonatal SLE |
| Renal problems | ||
| Rapidly progressive renal failure | MPO-ANCA, PR3-ANCA, anti-dsDNA and other lupus serologies, anti-phospholipid antibodies | Microscopic polyangiitis, WG, lupus nephritis, catastrophic antiphospholipid syndrome |
| Accelerated hypertension | Anti-Scl-70; anti-centromeres, anti-RNA-Polymerase III | Renal crisis in systemic sclerosis |
| Joint problems | ||
| Pain, stiffness, swelling with symptoms of systemic disease | Anti-CCP, RF and lupus serologies | RA, SLE |
| Ocular problems | ||
| Red, painful, photophobic eye | RF, anti-CCP, lupus serologies | RA, Behcet’s, juvenile RA, SLE |
| Gastrointestinal problems | ||
| Colicky abdominal pain | Lupus serologies | SLE mesenteric arteritis |
| Skin problems | ||
| Petechiae, palpable purpura, hemorrhagic blisters, ulcerations and gangrene | SLE and RA serologies | SLE, rheumatoid vasculitis |
| Neonatal skin rash | Anti-Ro/SSA, anti-La/SSB | Neonatal lupus |
| Hematological problems | ||
| Anemia, thrombocytopenia, leukopenia | Anti-DNA and lupus serologies; anti-erythrocyte, anti-platelet antibodies | SLE, autoimmune hemolytic anemia |
| Thrombocytopenia | Antiphospholipid antibodies | Antiphospholipid syndrome |