Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Association of Discoid Lupus with Clinical Manifestations and Damage Accrual in PROFILE: A Multiethnic Lupus Cohort.

Santiago-Casas1,  Yesenia C., Vila1,  Luis M., McGwin Jr.2,  G., Petri3,  Michelle, Ramsey-Goldman4,  Rosalind, Reveille5,  John D., Kimberly2,  Robert P.

University of Puerto Rico Medical Sciences Campus, San Juan, PR
University of Alabama at Birmingham, Birmingham, AL
Johns Hopkins University School of Medicine, Baltimore, MD
Northwestern University Feinberg School of Medicine, Chicago, IL
University of Texas Health Science Center at Houston, Houston, TX
Department of Medicine and Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL

Background/Purpose:

Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus and occurs in 15%–30% of patients with systemic lupus erythematosus (SLE). It is more common in African Americans and smokers. However, the association of DLE with other clinical features of lupus has not been clearly established. The aim of this study was to determine the association of DLE with clinical manifestations and disease damage in a large multiethnic SLE cohort.

Methods:

SLE patients (per ACR criteria), age >= 16 years, disease duration <= 10 years at enrollment, and defined ethnicity (African American, Hispanic or Caucasian), from a longitudinal cohort were studied. Socioeconomic-demographic features, clinical manifestations and disease damage [as per the Systemic Lupus International Collaborating Clinics Damage Index (SDI)] were determined. The association of DLE with clinical manifestations and disease damage was examined using multivariable logistic regression adjusting for age, gender, race/ethnicity, disease duration, years of education, and smoking.

Results:

A total of 2,228 SLE patients were studied. The mean (standard deviation, SD) age at diagnosis was 34.3 (12.8) years and the mean (SD) disease duration was 7.9 (6.0) years; 91.8% were females. Discoid lupus was observed in 393 (17.6%) of patients with SLE. In the multivariable analysis, patients with DLE were more likely to have malar rash (odds ratio [OR] 1.28, 95% confidence interval [95% CI] 1.02–1.62), photosensitivity (OR 1.66, 95% CI 1.30–2.13), oral ulcers (OR 1.35, 95% CI 1.07–1.70), leukopenia (OR 1.46, 95% CI 1.16–1.83) and vasculitis (OR 1.62, 95% CI 1.22–2.13), but less likely to have arthritis (OR 0.73, 95% CI 0.54–0.99), end-stage renal disease (ESRD) (OR 0.42, 95% CI 0.19–0.93), and antinuclear (OR 0.52, 95% CI 0.31–0.88), anti-dsDNA (OR 0.64, 95% CI 0.51–0.80) and anti-phospholipid antibodies (OR 0.71, 95% CI 0.52–0.98). No association was found with overall renal involvement. Patients with DLE had more damage accrual (OR 1.07, 95% CI 1.02–1.13), as well as some individual components of the SDI including chronic seizures (OR 1.84, 95% CI 1.08–3.13), alopecia (OR 5.71, 95% CI 3.91–8.35), scarring of the skin (OR 14.66, 95% CI 8.67–24.81), and skin ulcers (OR 2.43, 95% CI 1.06–5.60).

Conclusion:

In this cohort of SLE patients, discoid lupus was associated with mucocutaneous manifestations, integument damage, leukopenia, vasculitis, and chronic seizures, but a lower frequency of arthritis, ESRD and immunologic abnormalities. Our findings highlight the importance of surveillance of SLE patients with DLE, particularly because of the association with serious manifestations such as vasculitis and seizures.

To cite this abstract, please use the following information:
Santiago-Casas, Yesenia C., Vila, Luis M., McGwin Jr., G., Petri, Michelle, Ramsey-Goldman, Rosalind, Reveille, John D., et al; Association of Discoid Lupus with Clinical Manifestations and Damage Accrual in PROFILE: A Multiethnic Lupus Cohort. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1374
DOI:

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