Session Information
Date: Sunday, November 8, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session I
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Oral ulcers (OU) are a common manifestation of systemic lupus erythematosus (SLE). They are included in both classification criteria and disease activity indices. Despite this, there has been little done to further characterize them. This work was undertaken to evaluate the disease specific features associated with OU in SLE. We then sought to specifically evaluate a subgroup of individuals regarding the patient reported features of OU in SLE.
Methods: The prevalence of OU in a large SLE cohort was examined and their relationship to the other SLICC criteria explored using logistic regression. Phase 2 involved the administration of a questionnaire outlining the characteristics, location, duration and number of OU.
Results: There were 2417 SLE patients in the initial analysis. The frequency of OU in the cohort was 51.6%. Male gender (OR=0.48, 95% CI =0.35, 0.66) and African-American race (OR=0.52, 95% CI = 0.33, 0.80) were negatively associated with oral ulcers. The relationship between OU and the other SLICC clinical and laboratory criteria, after adjusting for ethnicity, are as outlined in Table1.
Oral ulcers were positively associated with cutaneous lupus, alopecia and arthritis. They were associated with pleurisy but not pericarditis. Oral ulcers were negatively associated with “seropositivity” (low complement, high anti-dsDNA) and renal lupus. 123 patients were surveyed (3 could give no details). 68 (56.6%) had as history of OU. Mean duration of OU was 7.43 days (range: 1 to 90). Regarding location, 22 (32.4%) described them on their tongue, 23 (33.8%) on the palate and 50 (73.5%) on their buccal mucosa. 34 (50%) described crops of OU. Addressing pain, 54 of the 68 patients provided information. 34 (63%) said that they only had painful episodes, 12 (22%) had only painless episodes, and 8 (15%) have both.
Table 1 Relationship between OU and the other SLE manifestations.
|
SLICC Criteria |
History of OU (%) |
No OU (%) |
Odds ratio |
95% CI |
P value (unadjusted) |
P value (adjusted for ethnicity) |
|
|
Acute cutaneous lupus |
Malar Rash |
55.6 |
42.4 |
1.58 |
(1.34,1.86) |
<.0001 |
<.0001 |
|
Bullous Lupus |
1.1 |
0.4 |
2.61 |
(0.91,7.43) |
0.0883 |
0.0731 |
|
|
Photosensitivity |
60.7 |
43.3 |
1.84 |
(1.56,2.17) |
<.0001 |
<.0001 |
|
|
Chronic cutaneous lupus |
Discoid Lupus |
20.4 |
18.4 |
1.38 |
(1.12,1.71) |
0.2124 |
0.0027 |
|
Alopecia |
60.9 |
49.2 |
2.11 |
(1.77,2.52) |
<.0001 |
<.0001 |
|
|
Arthritis |
74.2 |
69.3 |
1.32 |
(1.1,1.59) |
0.0078 |
0.0024 |
|
|
Serositis |
Pleurisy |
46.9 |
39.6 |
1.39 |
(1.18,1.64) |
0.0003 |
0.0001 |
|
Pericarditis |
22.1 |
21.8 |
1.12 |
(0.92,1.36) |
0.8705 |
0.2655 |
|
|
Renal |
Proteinuria |
37.8 |
50.7 |
0.68 |
(0.57,0.8) |
<.0001 |
<.0001 |
|
Neurologic |
Seizures |
9.5 |
9.5 |
1.01 |
(0.77,1.34) |
0.9906 |
0.9255 |
|
Acute Confusional State |
5.0 |
3.2 |
1.60 |
(1.05,2.43) |
0.0259 |
0.0297 |
|
|
Hemolytic Anemia |
8.5 |
11.7 |
0.75 |
(0.57,0.99) |
0.0120 |
0.0393 |
|
|
Leukopenia |
46.5 |
45.4 |
1.16 |
(0.99,1.37) |
0.6081 |
0.0718 |
|
|
Thrombocytopenia |
19.2 |
21.6 |
0.89 |
(0.73,1.09) |
0.1493 |
0.2493 |
|
|
ANA |
96.2 |
96.9 |
0.88 |
(0.56,1.38) |
0.3328 |
0.5775 |
|
|
Anti-dsDNA |
58.2 |
65.2 |
0.77 |
(0.65,0.91) |
0.0004 |
0.0022 |
|
|
Anti-Sm |
19.0 |
22.0 |
1.01 |
(0.82,1.25) |
0.0753 |
0.9244 |
|
|
Anti-phospholipid |
LAC |
25.7 |
27.1 |
0.88 |
(0.73,1.07) |
0.4738 |
0.1977 |
|
Anticardiolipin |
48.6 |
48.5 |
0.99 |
(0.84,1.16) |
0.9683 |
0.8645 |
|
|
Anti-beta 2 gly |
27.8 |
30.3 |
0.85 |
(0.67,1.07) |
0.2859 |
0.1682 |
|
|
Low complement |
C3 |
51.1 |
58.7 |
0.78 |
(0.66,0.92) |
0.0002 |
0.0034 |
|
C4 |
45.7 |
49.4 |
0.88 |
(0.75,1.04) |
0.0683 |
0.1274 |
|
|
Coombs |
17.3 |
23.4 |
0.75 |
(0.60,0.94) |
0.0008 |
0.0133 |
|
Conclusion: Mouth ulcers occur in 51% of SLE patients. They are negatively associated with “seropositivity” (meaning anti-dsDNA and low complement) and with renal lupus. Surprisingly, they are associated with pleurisy but not pericarditis. The majority occur on the buccal mucosa. In contradistinction to the ACR criteria, 63% of patients have painful episodes.
To cite this abstract in AMA style:
Durcan R, Fu W, Petri M. Oral Ulcers in Systemic Lupus Erythematosus: Characterization and Clarification of an Important Clinical Manifestation [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/oral-ulcers-in-systemic-lupus-erythematosus-characterization-and-clarification-of-an-important-clinical-manifestation/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/oral-ulcers-in-systemic-lupus-erythematosus-characterization-and-clarification-of-an-important-clinical-manifestation/