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Abstract Number: 1398

Practice-Based Differences Between Pediatric Rheumatologists and Dermatologists Caring for Children with Discoid Lupus

Lisa Arkin1, Kaveh Ardalan2, Heather Brandling-Bennett3, Yvonne Chiu4, Benjamin Chong5, Megan Curran6, Raegan Hunt7, Amy Paller8, Victoria P. Werth9,10, Marisa Klein-Gitelman6, Emily von Scheven11 and for the CARRA SLE workgroup, 1Department of Dermatology and Pediatrics;, University of Wisconsin School of Medicine & Public Health/American Family Children’s Hospital, Madison, WI, 2Division of Rheumatology; Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, IL, 3Division of Dermatology; Department of Pediatrics, Seattle Children’s Hospital/University of Washington School of Medicine, Seattle, WA, 4Department of Dermatology and Pediatrics, Medical College of Wisconsin / Children's Hospital of Wisconsin, Milwaukee, WI, 5Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, 6Division of Rheumatology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, IL, 7Departments of Dermatology and Pediatrics, Baylor College of Medicine / Texas Children’s Hospital, Houston, TX, 8Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine/Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 9Dermatology, University of Pennsylvania, Philadelphia, PA, 10Dermatology, Veterans Affairs Medical Center, Philadelphia, PA, 11Division of Rheumatology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Cutaneous lupus erythematosus, evidence-based practice, pediatrics and systemic lupus erythematosus (SLE)

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Session Information

Date: Monday, November 14, 2016

Session Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects - Poster II: Myositis, Systemic Lupus Erythematosus, Sjögren's Syndrome

Session Type: ACR Poster Session B

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

Background/Purpose: Discoid lupus erythematosus (DLE) is rare in children.  There are no consensus guidelines for management or screening for evolution to systemic lupus erythematosus (SLE). This study compared screening and treatment practice patterns among pediatric dermatologists and pediatric rheumatologists caring for children with DLE.

Methods: A survey was e-mailed to 292 pediatric rheumatologists (Childhood Arthritis & Rheumatology Research Alliance [CARRA]) and 200 pediatric dermatologists (Pediatric Dermatology Research Alliance [PeDRA]). The survey addressed the following domains: laboratory screening for SLE (at time of DLE diagnosis); risk factors impacting screening strategy for SLE; first/second-line systemic therapies; and topical therapies. Consensus was pre-defined as  ≥70% agreement from both subspecialties. 

Results:  Fifty-three pediatric rheumatologists and 69 pediatric dermatologists were included (18% and 35% response rates respectively). Both groups reported treating pediatric DLE (rheum n =48 [91%]; derm n= 65 [94%]), but >90% of respondents reported <10 DLE patients in their current practice. There was no consensus on the choice of labs for initial screening for SLE, but most respondents (rheum n = 42 [79%] vs derm n = 28 [41%]) chose the following panel: CBC/diff, renal/hepatic function, ESR, CRP, urine studies, complements, autoantibodies (i.e. dsDNA, SSA, SSB, RNP, Smith), anti-phospholipid antibodies. Of those who selected a partial laboratory work up (rheum n = 9 [17%]; derm n = 33 [48%]), only CBC (rheum n = 9 [100%]; derm n =32 [97%] and urinalysis (rheum n = 7 [78%]; derm n = 24 [73%]) achieved consensus as defined above. Other laboratory studies are listed in Table 1. There was consensus that the following baseline clinical features warrant more thorough SLE screening: 1st degree relative with SLE, positive autoantibodies, arthritis and nephritis. Rheumatologists more often initiated hydroxychloroquine as first-line therapy (rheum n = 24 [45%]; derm n = 9 [13%]) while dermatologists more frequently started with topical therapy (rheum n = 16 [30%]; derm n = 50 [72%]).  There was no consensus regarding appropriate choice of second-line systemic agents.

Conclusion: This study reveals lack of consensus between and among pediatric dermatologists and rheumatologists caring for children with DLE, underscoring the need for future study and collaboration. Knowledge gaps include risk factors for SLE, screening for SLE, optimal therapy, and patient outcomes. Collection of robust longitudinal observational data will aid in developing consensus for management of pediatric-onset DLE. Table 1. Laboratory studies selected for partial screening

Rheum (9) n, (%) Derm (33) n, (%)
Complete blood count with differential** 9 (100%) 32 (97%)
Urinalysis** 7 (78%) 24 (73%)
Complement 9 (100%) 16 (48%)
ESR 7 (78%) 17 (52%)
ANA 6 (67%) 31 (94%)
Basic metabolic panel 6 (67%) 18 (55%)
Hepatic function tests 6 (67%) 21 (64%)
Anti-ds DNA 5 (56%) 24 (73%)
Ro, La, Smith, and RNP 5 (56%) 18 (55%)
Urine protein:creatinine 5 (56%) 5 (15%)
CRP 3 (33%) 9 (27%)
Anti-phospholipid antibodies 0 (0%) 1 (3%)

**Consensus between specialties Funding: Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Friends of CARRA, CARRA Inc., and the Arthritis Foundation. Acknowledgements: The study authors would like to acknowledge the following CARRA Registry principal investigators and site coordinators: L. Abramson, E. Anderson, M. Andrew, N. Battle, M. Becker, H. Benham, T. Beukelman, J. Birmingham, P. Blier, A. Brown, H. Brunner, A. Cabrera, D. Canter, D. Carlton, B. Caruso, L. Ceracchio, E. Chalom, J. Chang, P. Charpentier, K. Clark, J. Dean, F. Dedeoglu, B. Feldman, P. Ferguson, M. Fox, K. Francis, M. Gervasini, D. Goldsmith, G. Gorton, B. Gottlieb, T. Graham, T. Griffin, H. Grosbein, S. Guppy, H. Haftel, D. Helfrich, G. Higgins, A. Hillard, J.R. Hollister, J. Hsu, A. Hudgins, C. Hung, A. Huttenlocher, A. Imlay, L. Imundo, C.J. Inman, J. Jaqith, R. Jerath, L. Jung, P. Kahn, A. Kapedani, D. Kingsbury, K. Klein, M. Klein-Gitelman, A. Kunkel, S. Lapidus, S. Layburn, T. Lehman, C. Lindsley, M. MacgregorHannah, M. Malloy, C. Mawhorter, D. McCurdy, K. Mims, N. Moorthy, D. Morus, E. Muscal, M. Natter, J. Olson, K. OÕNeil, K. Onel, M. Orlando, J. Palmquist, M. Phillips, L. Ponder, S. Prahalad, M. Punaro, D. Puplava, S. Quinn, A. Quintero, C. Rabinovich, A. Reed, C. Reed, S. Ringold, M. Riordan, S. Roberson, A. Robinson, J. Rossette, D. Rothman, D. Russo, N. Ruth, K. Schikler, A. Sestak, B. Shaham, Y. Sherman, M. Simmons, N. Singer, S. Spalding, H. Stapp, R. Syed, E. Thomas, K. Torok, D. Trejo, J. Tress, W. Upton, R. Vehe, E. von Scheven, L. Walters, J. Weiss, P. Weiss, N. Welnick, A. White, J. Woo, J. Wootton, A. Yalcindag, C. Zapp, L. Zemel, and A. Zhu.


Disclosure: L. Arkin, None; K. Ardalan, None; H. Brandling-Bennett, None; Y. Chiu, None; B. Chong, None; M. Curran, None; R. Hunt, None; A. Paller, None; V. P. Werth, None; M. Klein-Gitelman, None; E. von Scheven, None.

To cite this abstract in AMA style:

Arkin L, Ardalan K, Brandling-Bennett H, Chiu Y, Chong B, Curran M, Hunt R, Paller A, Werth VP, Klein-Gitelman M, von Scheven E. Practice-Based Differences Between Pediatric Rheumatologists and Dermatologists Caring for Children with Discoid Lupus [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/practice-based-differences-between-pediatric-rheumatologists-and-dermatologists-caring-for-children-with-discoid-lupus/. Accessed March 1, 2021.
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