Background/Purpose: Increased rates of co-existing autoimmune diseases in the systemic lupus erythematosus (SLE) population have been reported.¹ Little is known about the prevalence of autoimmune diseases in cutaneous lupus erythematosus (CLE) without SLE (CLE-only) patients. To address this knowledge gap, we sought to assess frequencies of and clinical factors associated with concomitant autoimmune diseases in patients with CLE-only.

Methods: A cross-sectional pilot study was conducted between November 2008 and February 2017 among patients enrolled in the Cutaneous Lupus Registry at University of Texas Southwestern Medical Center. Participants with CLE who met 4 out of 11 American College of Rheumatology (ACR) criteria for SLE were excluded. For each patient, we collected demographic and clinical information including concomitant autoimmune disease diagnoses, which were confirmed by other subspecialty records, and listed by Hayter and Cook.² The primary and secondary outcomes was presence of ≥1 autoimmune disease and individual autoimmune diseases, respectively. Univariable (e.g. chi-squared tests) and multivariable analyses (e.g. logistic regression) were used to compare differences in outcomes between CLE-only patients with and without co-existing autoimmune diseases.

Results: Of the 129 patients with CLE-only, 17.8% (23/129) were found to have a co-existing autoimmune disease. Rheumatoid arthritis and Sjogren’s syndrome (3.1% each) were the most frequent autoimmune diseases, followed by Grave’s disease and alopecia areata (2.3% each) (Table). Univariable analyses showed that CLE-only patients who were Caucasian (p=0.03), non-smokers (p=0.008), have subacute cutaneous lupus (p=0.04), or have positive anti-nuclear antibodies (p<0.0001) were more likely to have a concomitant autoimmune disease. Based on our multivariable analyses, CLE-only patients who were Caucasian (Odds ratio (OR):3.07, p=0.03), had non-smoking histories (OR:3.34, p=0.02), and had positive anti-nuclear antibodies (OR:5.03, p=0.002) were highly associated with having autoimmune diseases.

Conclusion: Our cohort of CLE-only patients, particularly those with Caucasian race, non-smoking history, and anti-nuclear antibodies, showed higher prevalence of co-existing autoimmune diseases than what is reported in the general population (4.5%).² Patients with CLE-only should be monitored closely for development of concomitant autoimmune conditions.

Table 1: Frequencies of autoimmune diseases in patients with CLE-only

*One participant had 3 coexisting autoimmune diseases and another participant had 2.

References: 1. Cervera R, et al. Medicine (Baltimore). 1993; 79 (2): 113-124.

2. Hayter SM, Cook MC. Autoimmun Rev. 2012;11:754-765.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/autoimmune-diseases-in-patients-with-cutaneous-lupus-erythematosus/