Session Information
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Discoid lupus erythematosus (DLE) progresses to systemic lupus erythematosus (SLE) in up to 28% of cases. The Systemic Lupus International Collaborating Clinics (SLICC) SLE criteria were developed to improve the American College of Rheumatology (ACR) criteria, but have not been assessed in DLE patients.
Methods: This was a retrospective study of 172 DLE patients enrolled in a cutaneous lupus database at the University of Pennsylvania. Patients were assessed for the presence of ACR and SLICC criteria using the database and respective electronic medical records. The Fischer’s exact test was used for each criterion in the ACR and SLICC to determine a difference between patients with DLE/SLE and DLE-only disease.
Results: Using the ACR criteria, 74 patients (52%) were classified as DLE/SLE and 68 (48%) as DLE-only, compared with 66 (46%) DLE/SLE and 76 (54%) DLE-only patients using the SLICC criteria (p=0.08). This net increase of 8 patients meeting ACR criteria was due to the presence of the photosensitivity criterion and fewer immunologic criteria under ACR. Due to the immunologic criteria requirement under SLICC, it can be challenging to determine an SLE diagnosis retrospectively. Overall, DLE/SLE patients were more likely than DLE-only patients to exhibit significant systemic symptoms with regard to arthritis (ACR 73% vs. 9%, p<0.0001; SLICC 70% vs. 18%, p<0.0001), serositis (ACR 22% vs. 0%, p<0.0001; SLICC 22% vs. 3%, p<0.0001), and renal disorder (ACR 27 % vs. 2%, p<0.0001; SLICC 33% vs. 0%, p<0.0001). SLE was more common in generalized DLE than in localized DLE using ACR (p=0.0001) and SLICC (p=0.0068) criteria. DLE/SLE patients were more likely to have worse skin disease compared to DLE-only patients when classified according to ACR criteria, with 40.5% of DLE/SLE patients having CLASITM activity ≥ 10 and 25.0% of DLE-only patients having CLASITM ≥ 10 (Table 1).
Conclusion: DLE/SLE patients have more significant internal disease than DLE patients who do not meet SLE criteria. Our findings trended toward the ACR criteria classifying more DLE patients with SLE than the SLICC criteria, particularly in patients without extensive laboratory testing. DLE-only patients may have significant skin disease with approximately 25% of DLE-only patients having moderate to severe skin disease.
| DLE with SLE n (%) | DLE without SLE n (%) |
P-value |
|
| CLASITM ≥ 10 |
30 (40.5) |
17 (25.0) |
0.0493* |
| CLASITM < 10 |
44 (59.5) |
51 (75.0) |
|
| Table 1A. Skin activity in DLE/SLE vs DLE-only patients using ACR criteria. DLE/SLE patients are more likely to have worse skin disease compared to DLE-only patients when classified according to the ACR criteria. | |||
| DLE with SLE n (%) | DLE without SLE n (%) |
P-value |
|
| CLASITM ≥ 10 |
27 (40.9) |
20 (26.3) |
0.0653 |
| CLASITM < 10 |
39 (59.1) |
56 (73.7) |
|
| Table 1B. Skin activity in DLE/SLE vs DLE-only patients using SLICC criteria. There is a trend of DLE/SLE patients having worse skin disease compared to DLE-only patients when classified according to the SLICC criteria. | |||
To cite this abstract in AMA style:
Presto JK, Haber JS, Werth VP. Using the American College of Rheumatology and Systemic Lupus International Collaborating Clinics Criteria to Measure Disease Severity in Discoid Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/using-the-american-college-of-rheumatology-and-systemic-lupus-international-collaborating-clinics-criteria-to-measure-disease-severity-in-discoid-lupus-erythematosus/. Accessed .« Back to ACR/ARHP Annual Meeting 2016
ACR Meeting Abstracts - https://acrabstracts.org/abstract/using-the-american-college-of-rheumatology-and-systemic-lupus-international-collaborating-clinics-criteria-to-measure-disease-severity-in-discoid-lupus-erythematosus/