Background/Purpose: Cutaneous lupus erythematosus (CLE) lesions are difficult to treat and medications are often chosen based only on provider experience. Thus, we chose to assess the role of autoantibodies in predicting the response to disease modifying medication in subjects with subacute (sCLE) and discoid (DLE) lupus.

Methods: 306 subjects with a biopsy proven CLE diagnosis at the University of Michigan (168 sCLE; 138 DLE) between 2000-2015 were studied. Subjects with more than 2 visits with either Rheumatology or Dermatology were included in this study to assess treatment response. Demographics, clinical, immunological and SLE-related medications, including topical corticosteroids and hydroxychloroquine (HCQ) were collected. The 1997 ACR SLE criteria were used to determine the presence or absence of systemic disease at the time of CLE diagnosis. Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) for either activity or damage were assessed at the time of diagnosis and on the subsequent follow-up visit to assess response. Univariate and multivariate logistic regression analysis was used to evaluate the role of anti-Ro positivity in CLASI activity, response to HCQ and topical steroids in DLE and sCLE patients.

Results: A female predominance was observed in both groups (sCLE: 84% and DLE: 79%) with a higher percentage of whites in the sCLE (85%) and more African Americans in the DLE (38%) subset. Age at the time of skin biopsy was (mean ± SEM) 50±17 for sCLE and 46±12 for DLE; p=0.01. ACR criterion for SLE was met in 59% of subjects with sCLE and in 28% in DLE (P<0.01). In DLE, but not sCLE, patients,simple linear regression and multivariate linear regression adjusting for age, gender, race, SLE diagnosis, lupus nephritis, the ACR criterion, marriage status, thyroid cancer status, malignancy, ANA status, Anti-sm status, APS status, and dsDNA revealed that the presence of Anti-Ro Ab is associated with higher levels of CLASI activity at the time of biopsy (simple linear regression estimate for difference between Anti-Ro positive and Anti-Ro negative: 1.83, 95% CI for difference: 0.51-3.16; P=0.007 and multivariate estimate for difference 2.27, 95% CI 0.55-4; P=0.01). Univariate logistic regression revealed that the presence of Anti-Ro in DLE is associated with decreased response to HCQ (OR: 0.34, CI: 0.14-0.83; P= 0.02) and topical steroids (OR: 0.12, CI: 0.02-0.61; P= 0.01) but is associated with increased treatment response in sCLE patients for HCQ (OR: 2.28, CI: 1.20-4.39; P=0.01). Multivariate logistic regression adjusting for age, gender, SLE diagnosis, smoking, ANA status, and Anti-sm status suggested a trend toward increased response to topical steroids in the sCLE group (OR: 3, CI: 0.81-12.94,; p=0.11). No significant predictive value for anti-Ro was noted when patients were categorized as CLE-only vs. systemic lupus.

Conclusion: Sub-classification of CLE patients by cutaneous lesion subtype and anti-Ro antibody status may help to predict which patients will respond to first line treatments such as topical steroids or hydroxychloroquine. This knowledge may help to lower the threshold for changing or modifying treatment in patients with a higher risk of non-response. 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/anti-ro-positivity-is-a-predictor-of-responsiveness-to-topical-steroids-or-hydroxychloroquine-in-patients-with-discoid-but-not-subacute-cutaneous-lupus/