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.
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 November 11, 2019.
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