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Table 1 Autoimmune serology assessment for possible rheumatic disease in emergency settings

From: Detection of autoantibodies in a point-of-care rheumatology setting

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