IDENTIFICATION OF PATIENT SUBSETS AMONG THOSE PRESUMPTIVELY DIAGNOSEDWITH, REFERRED, AND OR FOLLOWED UP FOR SYSTEMIC LUPUS-ERYTHEMATOSUS AT A LARGE TERTIARY CARE CENTER/

Objective, To identify different subsets of patients from a large tert iary care center who were presumptively referred for and/or diagnosed with systemic lupus erythematosus (SLE) (or followed up), Methods. All patients who were referred, followed up, and/or diagnosed with SLE at our center, who had disease duration of less than or equal to 5 years , and who resided in Alabama, were identified and their charts reviewe d and abstracted, Results, Abstracted data were reviewed by 3 rheumato logists, and patients were assigned to 1 of 3 categories: 1) SLE by th e American College of Rheumatology (ACR; formerly, the American Rheuma tism Association) criteria, 2) clinical SLE but not meeting 4 of the A CR criteria, or 3) fibromyalgia-like manifestations with antinuclear a ntibody (ANA) positivity, There were 90 patients in the first group (c riteria), 22 in the second group (clinical), and 37 in the third group (fibromyalgia-like), Patients in all 3 groups were predominantly wome n, Only 5% of the fibromyalgia-like group were African-American, compa red with 55-65% for the other 2 groups. Organ system involvement occur red with comparable frequency in the first 2 groups, but mucocutaneous and hematologic abnormalities were more frequent in the criteria grou p; in contrast, the patients with fibromyalgia-like symptoms primarily presented with arthralgias/ myalgias, fatigue, depression, and sleep disturbances, as well as mucocutaneous manifestations, Conclusion, Whe n the ACR criteria for SLE are used to determine eligibility for lupus studies, a group of patients with clinically unequivocal SLE are excl uded, A group of patients with fibromyalgia-like manifestations, who t est positive for ANA and differ clinically and sociodemographically fr om the patients in the other 2 groups, very likely do not belong withi n the spectrum of SLE.