Differentiating between UCTD and early-stage SLE: from definitions to clinical approach

Differentiating between the early stages of systemic lupus erythematosus (SLE) and undifferentiated connective tissue disease (UCTD) can be challenging. In this Review, the authors summarize current knowledge on UCTD and early-stage SLE and discuss clinical approaches to diagnosing these conditions. Systemic lupus erythematosus (SLE) is an autoimmune disease with heterogeneous clinical manifestations that can potentially affect every organ and system. SLE is usually identified on the basis of clinical or serological manifestations; however, some individuals can present with signs and symptoms that are consistent with SLE but are not sufficient for a definite diagnosis. Disease in these individuals can either progress over time to definite SLE or remain stable, in which case their disease is often described as intermediate, possible or probable SLE. Alternatively, such individuals might have undifferentiated connective tissue disease (UCTD). Being able to differentiate between those with stable UCTD and those with SLE at an early stage is important to avoid irreversible target-organ damage from occurring. This Review provides insight into existing and evolving perceptions of the early stages of SLE, including clinical and mechanistic considerations, as well as potential paths towards early identification and intervention. Further research into the earliest phases of SLE will be important for the development of targeted diagnostic approaches and biomarkers for the identification of individuals with early disease who are likely to progress to definite SLE.

Automated summary

This review summarizes the differentiation between early systemic lupus erythematosus (SLE) and undifferentiated connective tissue disease (UCTD), as well as clinical approaches to diagnosing these conditions. It emphasizes the importance of accurately distinguishing between stable UCTD and early-stage SLE to prevent irreversible organ damage.