Do my lab values indicate SLE or rheumatoid arthritis?

Question

Hello doctor,

I have to confirm whether I have systemic lupus erythematosus or rheumatoid factor.

Clinical examination:

ANA positive with a titer of 5040.
Anti‑dsDNA negative.
Anti‑CCP negative.
Anti‑histone positive with a titer of 90.
ENA profile normal.
APLS profile normal.
ESR and CRP are elevated.
Occasional low TLC in the recent past.
Hemoglobin fluctuates.
Weight loss.

I received antitubercular therapy (Marine P‑Fort, tuberculosis drugs) for one year for dural venous sinus thrombosis a couple of years ago. Six months later, the following symptoms appeared:

Polymigratory arthralgia and myalgia.
A feverish feeling.
Weight loss.
No rash.
Unsure about photosensitivity.

The physician who treated me with antitubercular therapy stated that this was drug‑induced lupus and that it would resolve after a few months. However, it has persisted for three to four years. Over these years, I have been treated separately with corticosteroids, NSAIDs, Methotrexate, Leflunomide, and Tofacitinib without response. I have now been on Mycophenolate Mofetil with Leflunomide for the past two and a half months, and it is gradually slowing down the disease.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Based on your laboratory results and history, the picture is more in favour of systemic lupus erythematosus (SLE) rather than rheumatoid arthritis (RA). Your strongly positive antinuclear antibody (ANA), elevated anti‑histone antibody titres, intermittent low white blood cell (WBC) counts, raised erythrocyte sedimentation rate (ESR) and C‑reactive protein (CRP), migratory joint and muscle pains, and systemic symptoms, including a feverish feeling and weight loss, point toward lupus.

The negative anti‑double‑stranded DNA (anti‑dsDNA) and extractable nuclear antigen (ENA) profile, along with positive anti‑histone antibodies, suggest that this is drug‑induced lupus related to your previous tuberculosis treatment. However, the persistence of symptoms for several years despite the cessation of tuberculosis drugs indicates that it has evolved into a chronic, lupus‑like autoimmune disease rather than being purely drug‑induced.

Rheumatoid arthritis is unlikely because both anti‑cyclic citrullinated peptide (anti‑CCP) and rheumatoid factor are negative, and your symptoms and laboratory profile conform more closely to lupus. Your current improvement on Mycophenolate Mofetil (MMF) and Leflunomide further supports an autoimmune inflammatory condition such as lupus. Therefore, you have drug‑induced systemic lupus erythematosus, not rheumatoid arthritis.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.