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How would you approach the work up of SLE in a patient over 80 years old?

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Would you feel comfortable diagnosing SLE in a woman with AIHA, lymphadenopathy, and positive ANA/dsDNA/Coombs antibodies but who does not meet research classification criteria?

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3 Answers
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Rheumatology · University of Cincinnati
Answered on

Elderly onset lupus is uncommon and in the past twenty-five years has been reported to occur in as few as 6% of patients to as many as 19% of patients with the diagnosis of lupus. Typical clinical presentations tend to include arthritis/arthralgias, fever, weight loss, lymphadenopathy, serositis, si...

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Rheumatology · Uniformed Services University of the Health Sciences (USUHS)
Answered on · Updated on

In summary, we have a woman in her 80's with AIHA, lymphadenopathy, and positive ANA/dsDNA/Coombs antibodies (I assume direct Coombs Ab is positive with her "warm" AIHA). You have done an excellent job of ruling out other common causes of AIHA (I'm sure you included checking for HIV, EBV, Hep C, and...

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Rheumatology · Duke University Medical Center
Answered on · Updated on

Excellent responses to this question - wanted to add a comment to please consider other mimics of SLE in your differential as you work through the case, particularly given her advanced age. For example, lymphoproliferative disorders (such as Castleman's) and hematologic malignancy can be associated ...

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