Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Prior studies suggest that cutaneous discoid lupus (DLE) is a marker for less severe disease with a low frequency of nephritis and end-stage renal disease among SLE patients. These past studies have not included diagnostic confirmation of DLE by expert dermatologists and did not adjust for medication use. We investigated associations of validated cases of DLE with other specific SLE manifestations in a large validated SLE Cohort.
Methods: Our academic hospital SLE registry contains data on 5,030 patients seen for potential SLE, 1970-2011. Inclusion criteria for this study were: definite SLE per treating rheumatologist and an SLE expert, 4/11 of 1997 ACR classification criteria for SLE, >2 visits and >3 months of follow-up, and a documented year of SLE diagnosis. The presence of DLE was validated by an expert dermatologist with review of multispecialty notes, pathology and digital images, when available. We collected SLE manifestations, medication and serologic data from review of electronic medical records. We tested for associations between DLE and each of the ACR SLE criteria, as well as end-stage renal disease (ESRD), using multivariable-adjusted logistic regression analyses.
Results: Of 1,043 SLE patients included, 92% were female and 51% White, 100% were ANA positive, 66% were anti-dsDNA positive. Mean age at diagnosis was 32 years (± 13) and mean duration of follow-up was 10 years (± 6.5). DLE (n=117) was significantly associated with the presence of photosensitivity, leukopenia and anti-Smith antibodies (Table). DLE was inversely associated with both arthritis and pleuritis. We found no significant associations between DLE and nephritis or ESRD.
Conclusion: In this large cohort of SLE patients, we have found an increased frequency of photosensitivity, leukopenia and anti-Smith antibodies among SLE patients with DLE and an inverse association of DLE with both pleuritis and arthritis. We did not observe the inverse associations of DLE with anti-dsDNA antibodies, lupus nephritis, or ESRD that have been noted in other studies. These findings have important implications for prognosis among patients with DLE and possibly for different underlying pathophysiologies of SLE subtypes.
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Table. Associations between Discoid Lupus (n=117) and other ACR Criteria for SLE and End-Stage Renal Disease |
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SLE Manifestation |
Number with DLE |
Number without DLE |
OR* (95% CI) |
p-value |
|
Anti-Smith (n=246) |
45 |
201 |
2.41 (1.58-3.69) |
<0.01 |
|
Photosensitivity (n=434) |
60 |
374 |
1.63 (1.09-2.44) |
0.02 |
|
Leukopenia (n=351) |
50 |
301 |
1.55 (1.03-2.32) |
0.04 |
|
Pleuritis (n=380) |
31 |
349 |
0.56 (0.36-0.87) |
0.01 |
|
Arthritis (n=817) |
79 |
738 |
0.49 (0.31-0.76) |
<0.01 |
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No significant associations between discoid lupus and the following were found: malar rash, oral ulcers, pericarditis, proteinuria, casts, lupus nephritis, seizure, psychosis, anemia, lymphopenia, thrombocytopenia, anti-dsDNA, antiphospholipid antibodies, end-stage renal disease |
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*OR= odds ratio, adjusted: Multivariable logistic regression analyses modeling the odds ratio of DLE associated with each SLE manifestation or laboratory finding separately, adjusted for age at diagnosis, sex, race/ethnicity, disease duration, ever medication use (azathioprine, cyclophosphamide, hydroxychloroquine, methotrexate, mycophenolate mofetil, systemic corticosteroids) |
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Disclosure:
J. F. Merola,
None;
C. Iversen,
None;
J. A. Gomez-Puerta,
None;
T. Norton,
None;
H. Tsao,
None;
P. H. Schur,
None;
E. M. Massarotti,
None;
B. L. Bermas,
None;
K. H. Costenbader,
None.
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