Rheumatoid Arthritis vs Systemic Lupus Erythematosus
Rheumatoid Arthritis and Systemic Lupus Erythematosus are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Rheumatoid Arthritis vs Systemic Lupus Erythematosus at a glance
- Rheumatoid Arthritis: Chronic symmetric inflammatory polyarthritis with autoantibodies and erosive joint damage.
- Systemic Lupus Erythematosus: Multisystem autoimmune disease with autoantibodies against nuclear antigens and immune-complex tissue injury.
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Side-by-side comparison
| Feature | Rheumatoid Arthritis | Systemic Lupus Erythematosus |
|---|---|---|
| At a glance | Chronic symmetric inflammatory polyarthritis with autoantibodies and erosive joint damage. | Multisystem autoimmune disease with autoantibodies against nuclear antigens and immune-complex tissue injury. |
| Classic presentation | Symmetric MCP/PIP/wrist swelling with positive MCP/MTP squeeze test, plus rheumatoid nodules in seropositive disease.; Insidious symmetric polyarthritis of small joints (MCP, PIP, wrists, MTPs); Morning stiffness lasting >1 hour, improving with activity; Fatigue, low-grade fever, weight loss; Hand weakness and difficulty with grip;… | Constitutional: fatigue, low-grade fever, weight loss; Mucocutaneous: malar (butterfly) rash sparing nasolabial folds, discoid lesions, photosensitivity, oral or nasal ulcers (often painless), nonscarring alopecia; Musculoskeletal: symmetric small-joint polyarthralgia/arthritis, typically nonerosive (Jaccoud arthropathy if deforming);… |
| Workup / key labs | 2010 ACR/EULAR classification: score ≥6 of 10 across (a) joint involvement, (b) serology (RF/anti-CCP), (c) acute-phase reactants, and (d) symptom duration ≥6 weeks classifies as RA.; RF and anti-CCP (anti-CCP higher specificity; both predict erosive disease); ESR and CRP (elevated, used to track activity); CBC (normocytic anemia of… | EULAR/ACR 2019 classification criteria: ANA ≥1:80 as entry, then weighted clinical and immunologic domains (total ≥10 points classifies).; ANA — screening test; sensitivity >95% but low specificity; Anti-dsDNA — specific; titer correlates with disease activity (especially nephritis); Anti-Smith — highly specific; Anti-Ro/SSA,… |
| Imaging | Plain radiographs of hands and feet — periarticular osteopenia, symmetric joint-space narrowing, marginal erosions (MTPs often earliest); Ultrasound or MRI — more sensitive for early synovitis and erosions before plain-film changes; Cervical spine flexion/extension films in established disease to assess atlantoaxial subluxation prior to… | Renal biopsy — definitive for lupus nephritis classification (ISN/RPS classes I-VI); guides immunosuppression; Echo if pericardial effusion or Libman-Sacks endocarditis suspected; MRI brain for neuropsychiatric SLE workup |
| First-line treatment | Early DMARD therapy within 3 months of diagnosis — methotrexate is anchor drug; start 10-15 mg PO/SC weekly with folic acid 1 mg daily; Conventional DMARDs — methotrexate, hydroxychloroquine, sulfasalazine, leflunomide (often combined as 'triple therapy'); Bridging low-dose prednisone (≤10 mg/day) until DMARD takes effect; taper as… | Sun protection and smoking cessation for all patients; Hydroxychloroquine 200-400 mg/day — foundational for all SLE; reduces flares, organ damage, and mortality (baseline eye exam, annually after 5 years); NSAIDs — ibuprofen, naproxen — for mild musculoskeletal or serositis symptoms (caution with renal disease); Low-dose glucocorticoids… |
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