ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1809

Influence of Solar Radiation in Cutaneous Manifestations of Lupus: Data from the Gladel Cohort

Marina Scolnik1, Luis J. Catoggio1, Enrique R. Soriano1, Daniel Wojdyla2, Alejandro Alvarellos3, Nilzio A Da Silva4, Eduardo Ferreira Borba5, Emilia Sato6, Antonio Iglesias-Gamarra7, Marlene Guibert-Toledano8, Sergio Jacobelli9, Ignacio Garcia de la Torre10, Maria Josefina Sauza del Pozo11, Eduardo M. Acevedo-Vásquez12, Maria H Esteva-Spinetti13, Graciela S. Alarcon14 and Bernado Pons-Estel15, 1Rheumatology Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 2GLADEL consultant, Rosario, Argentina, 3Hospital Privado de Córdoba, Servicio de Reumatologia, Cordoba, Argentina, 4Faculdade de Medicina da Universidade Federal de Goiás, Goiania, Brazil, 5Rheumatology, Hospital das Clinicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil, 6Rheumatology Div/Dept of Med, Escola Paulista de Medicina - Universidade Federal de São Paulo, Sao Paulo, Brazil, 7Facultad de Medicina, Universidad del Bosque, Bogota, Colombia, 8Centro de Investigaciones Médico Quirúrgicas, Habana, Centro de Investigaciones Médico Quirúrgicas, Habana, La Habana, Cuba, 9Medicine / Rheumatology, Pontificia Universidad Catolica de Chile, Santiago, Chile, 10Hospital General de Occidente, Guadalajara, Mexico, 11Servicio de Reumatología, Instituto Mexicano de Seguro Social, Hospital de Especialidades Nº 25, Monterrey, Mexico, 12Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru, 13Unidad de Reumatología, Hospital Central de San Cristóbal, San Cristobal, Venezuela (Bolivarian Republic of), 14Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 15Sanatorio Parque, Rosario, Argentina

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords:

Session Information

Date: Monday, November 14, 2016

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster II: Damage Accrual and Quality of Life

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Classically, it has been thought that sun exposure is a risk factor for developing cutaneous manifestations in Systemic Lupus Erythematosus. On the other hand, in experimental studies UV radiation has a number of immunomodulatory effects and stimulates vitamin D synthesis. Our objective was to examine the mucocutaneous manifestations of SLE patients from the GLADEL cohort in relation to solar radiation of the place where they lived along Latin America by performing an ecological study.

Methods: GLADEL patients were categorized according to solar radiation (insolation on horizontal surface) of the Rheumatology Center where they were recruited, ascertained between the period of cohort follow up (1995-2004); this was obtained using NASA Surface meteorology and Solar Energy estimator (https://eosweb.larc.nasa.gov/cgi-bin/sse/[email protected]). Alopecia, photosensitivity, malar rash, discoid lesions, oral ulcers and subacute cutaneous lupus at cohort entry and during follow up were examined in multivariate models in relation to the average daily solar radiation of the city of residence (as a continuous variable) and other possible confounders.

Results: GLADEL cohort included 1480 lupus patients, with a disease duration < 2 years at entry, 89.9 % female (CI 88-91), mean age 29.5 years (SD 12.3), median follow up 52 months (IQR 24-70), from 34 centers of 22 cities of 9 countries in Latin America. Latitudes of these centers varied between -38° S (Mar del Plata, Argentina) and 25.7° N (Monterrey, Mexico) and mean daily solar radiation varied between 4.44 Kwh/m2/day (Porto Alegre, Brazil) and 6.08 Kwh/m2/day (Recife, Brazil) (Table 1). When entering the cohort, 1191 patients (80.47 %) had one or more of the cutaneous manifestations mentioned above and 434 patients (29.31%) developed new skin involvement during follow up. In logistic regression analysis after adjusting for age, gender, ethnic group, urban residence, latitude, antimalarial use and antibodies (anti DNA, anti Sm, anti Ro, antiphospholipid, low C3), living in a city with higher daily solar radiation (examined at 1 Kwh/m²/day increments) was not associated to any of the cutaneous manifestations at disease onset or during follow up (Table 2).

Conclusion:  In the GLADEL cohort, the average solar radiation of the city of residence was not associated with an increased risk of developing cutaneous manifestations. Table 1. Latitude and solar radiation of GLADEL patients’ cities of residence.

City Latitude Mean daily solar radiation (1995-2004) (Kwh/m2/day) Lupus patients in GLADEL, N (% )
Monterrey, Mexico

25.68 N

5.28

32 (2.2)

La Habana, Cuba

23.13 N

5.80

27 (1.8)

Aguas Calientes, Mexico

21.88 N

6.00

20 (1.3)

Guadalajara, Mexico

20.67 N

5.88

55 (3.7)

Mexico DF, Mexico

19.43 N

5.59

184 (12.4)

Guatemala, Guatemala

14.64 N

5.32

29 (1.9)

Caracas, Venezuela

10.49 N

5.64

72 (4.9)

San Cristobal, Venezuela

7.77 N

4.93

22 (1.5)

Medellin, Colombia

6.25 N

4.53

98 (6.6)

Bogota, Colombia

4.61 N

4.81

80 (5.4)

Recife, Brazil

-8.05 S

6.08

20 (1.3)

Lima, Peru

-12.05 S

5.53

100 (6.8)

Goiana, Brazil

-16.64 S

5.46

55 (3.7)

Campinas, Brazil

-22.90 S

5.11

40 (2.7)

Sao Pablo, Brazil

-23.63 S

4.67

102 (6.9)

Porto Alegre, Brazil

-30.03 S

4.44

32 (2.2)

Cordoba, Argentina

-31.40 S

5.16

92 (6.2)

Rosario, Argentina

-32.95 S

4.82

119 (8.0)

Santiago, Chile

-33.46 S

5.53

117 (7.9)

Buenos Aires, Argentina

-34.60 S

4.69

92 (6.2)

La Plata, Argentina

-34.92 S

4.67

44 (2.9)

Mar del Plata, Argentina

-38.00 S

4.50

48 (3.2)

Table 2. Associations of average daily solar radiation of city of residence (examined at increments of 1 Kwh/m2/day) by multivariable logistic regression analysis

Clinical manifestation

OR

(manifestation before/at cohort inclusion)

OR

(new manifestation)

OR

(manifestation during follow up)

Alopecia

0.79 (0.61-1.02)

1.35 (0.92-1.98)

1.08 (0.83-1.42)

Oral/nasal ulcers

0.81 (0.62-1.04)

1.05 (0.66-1.69)

0.74 (0.53-1.03)

Photosensitivity

0.79 (0.62-1.03)

0.63 (0.39-1.04)

0.81 (0.60-1.09)

Subacute cutaneous lupus

1.21 (0.57-2.54)

0.81 (0.31-2.13)

0.7 (0.30- 1.62)

Malar rash

0.92 (0.71-1.18)

1.41 (0.91-2.16)

1.17 (0.89-1.52)

Discoid lesions

1.24 (0.82-1.88)

1.83 (0.81-4.11)

1.29 (0.77-2.18)

Any of the previous

0.88 (0.64-1.23)

1.32 (1.00-1.75)

1.23 (0.95-1.59)

Disclosure: M. Scolnik, None; L. J. Catoggio, None; E. R. Soriano, None; D. Wojdyla, None; A. Alvarellos, None; N. A. Da Silva, None; E. F. Borba, None; E. Sato, None; A. Iglesias-Gamarra, None; M. Guibert-Toledano, None; S. Jacobelli, None; I. Garcia de la Torre, None; M. J. Sauza del Pozo, None; E. M. Acevedo-Vásquez, None; M. H. Esteva-Spinetti, None; G. S. Alarcon, None; B. Pons-Estel, None.

To cite this abstract in AMA style:

Scolnik M, Catoggio LJ, Soriano ER, Wojdyla D, Alvarellos A, Da Silva NA, Borba EF, Sato E, Iglesias-Gamarra A, Guibert-Toledano M, Jacobelli S, Garcia de la Torre I, Sauza del Pozo MJ, Acevedo-Vásquez EM, Esteva-Spinetti MH, Alarcon GS, Pons-Estel B. Influence of Solar Radiation in Cutaneous Manifestations of Lupus: Data from the Gladel Cohort [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/influence-of-solar-radiation-in-cutaneous-manifestations-of-lupus-data-from-the-gladel-cohort/. Accessed .

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