Background/Purpose: The rash of discoid lupus erythematosus (DLE) has been reported in 10-25% of patients with systemic lupus erythematosus (SLE). Prior reports suggest that DLE may be protective against severe disease in SLE; however, most studies have consisted of convenience samples of predominantly White patients. Although the incidence and prevalence of SLE is 3-4 times higher among individuals of African descent, and recent findings suggest that Blacks are more susceptible to DLE than Whites, no study has yet been conducted with a representative sample of Black SLE patients. We examined the association of DLE with clinical manifestations and disease outcomes in a predominantly Black community-based cohort of SLE patients in the Southeastern United States.

Methods: Data was collected from the Wave 1 (2011-12) annual survey of Georgians Organized Against Lupus (GOAL). GOAL is a large prospective cohort of validated SLE patients primarily derived from the Georgia Lupus Registry (GLR), a population-based registry of lupus patients in Atlanta, Georgia. GOAL includes patients of the full sociodemographic spectrum and collects self-reported data on health status, disease activity, and organ damage. SLE was defined by the presence of at least 4 American College of Rheumatology (ACR) criteria, or 3 ACR criteria and a diagnosis of SLE by a rheumatologist. DLE was assessed by chart review according to dermatologist or rheumatologist clinical evaluation with or without biopsy confirmation. We examined the association of DLE with clinical features and disease status, calculating the OR and 95% CI adjusted for demographic variables and disease duration.

Results: Among 767 SLE patients, 196 (26%) had DLE. DLE was present in 168/597 (28%) Blacks versus 25/156 (16%) Whites (p=0.008), and 18/45 (40%) males versus 178/722 (25%) females (p=0.02). Mean educational attainment (years) was 13.7 (SD 2.8) and 14.4 (SD 2.9) in patients with and without DLE, respectively (p=0.004), and mean disease duration (years) was 15.5 (SD 10.4) and 12.6 (SD 8.1) in these two respective groups (p=0.0001).

Conclusion: DLE occurred in 26% of SLE patients, suggesting a stronger association of discoid rash with systemic manifestations than formerly believed. Males and Blacks were primarily affected. Consistent with prior studies, we found an association of DLE with non-specific cutaneous manifestations in SLE patients. Notably, DLE appears to be protective of renal and neurological involvement. Our findings may reflect more accurately the true epidemiology of DLE in high-risk SLE populations given the demographic makeup of this community-based cohort. Despite differences in clinical phenotypes, disease outcomes were similar in patients with and without DLE. Over 50% of patients reported poor health, organ damage, or severe disease activity, regardless of the presence of DLE. Our data suggest that environmental factors play a major role in outcomes of high-risk SLE patients.