Association of discoid lupus erythematosus with other clinical manifestations among patients with systemic lupus erythematosus

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

卷:69

Article

Merola, Joseph F.^1,2  Prystowsky, Stephen D.³  Iversen, Christina¹  Gomez-Puerta, Jose A.¹  Norton, Tabatha¹  Tsao, Peter¹  Massarotti, Elena¹  Schur, Peter¹  Bermas, Bonnie¹  Costenbader, Karen H.¹ 

[1] Harvard Univ, Sch Med, Brigham & Womens Hosp, Dept Med,Div Rheumatol Allergy & Immunol, Boston, MA 02118 USA

[2] Harvard Univ, Sch Med, Brigham & Womens Hosp, Dept Dermatol, Boston, MA 02118 USA

[3] NYU Med Ctr, Dept Dermatol, New York, NY 10016 USA

关键词: cutaneous lupus erythematosus;    discoid lupus erythematosus;    epidemiology;    prognosis;    systemic lupus erythematosus;   

DOI  :  10.1016/j.jaad.2013.02.010

来源: Elsevier

【 摘 要 】

Background: Cutaneous discoid lupus erythematosus (DLE) among patients with systemic lupus erythematosus (SLE) may be associated with less severe disease and with low frequency of nephritis and end-stage renal disease (ESRD). Objective: We sought to investigate associations between confirmed DLE and other SLE manifestations, adjusting for confounders. Methods: We identified patients with rheumatologist confirmation, according to 1997 American College of Rheumatology (ACR) SLE classification criteria, more than 2 visits, longer than 3 months of follow-up, and documented year of SLE diagnosis. DLE was confirmed by a dermatologist, supported by histopathology and images. SLE manifestations, medications, and serologies were collected. Multivariable-adjusted logistic regression analyses tested for associations between DLE and each of the ACR SLE criteria, and ESRD. Results: A total of 1043 patients with SLE (117 with DLE and 926 without DLE) were included in the study. After multivariable adjustment, DLE in SLE was significantly associated with photosensitivity (odds ratio [OR] 1.63), leukopenia (OR 1.55), and anti-Smith antibodies (OR 2.41). DLE was significantly associated with reduced risks of arthritis (OR 0.49) and pleuritis (OR 0.56). We found no significant associations between DLE and nephritis or ESRD. Limitations: Cross-sectional data collection with risk of data not captured from visits outside system was a limitation. Conclusions: In our SLE cohort, DLE was confirmed by a dermatologist and we adjusted for possible confounding by medication use, in particular hydroxychloroquine. We found increased risks of photosensitivity, leukopenia, and anti-Smith antibodies and decreased risks of pleuritis and arthritis in patients with SLE and DLE. DLE was not related to anti-double-stranded DNA antibodies, lupus nephritis, or ESRD. These findings have implications for prognosis among patients with SLE.

【 授权许可】

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