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Association of discoid lupus erythematosus with other clinical manifestations among patients with systemic lupus erythematosus - 14/06/13

Doi : 10.1016/j.jaad.2013.02.010 
Joseph F. Merola, MD a, b, , Stephen D. Prystowsky, MD c, Christina Iversen a, Jose A. Gomez-Puerta, MD, PhD a, Tabatha Norton, BA a, Peter Tsao, BS, MPH a, Elena Massarotti, MD a, Peter Schur, MD a, Bonnie Bermas, MD a, Karen H. Costenbader, MD, MPH a
a Department of Medicine, Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 
b Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 
c Department of Dermatology, New York University Medical Center, New York, New York 

Reprint requests: Joseph F. Merola, MD, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02118.

Abstract

Background

Cutaneous discoid lupus erythematosus (DLE) among patients with systemic lupus erythematosus (SLE) may be associated with less severe disease and with low frequency of nephritis and end-stage renal disease (ESRD).

Objective

We sought to investigate associations between confirmed DLE and other SLE manifestations, adjusting for confounders.

Methods

We identified patients with rheumatologist confirmation, according to 1997 American College of Rheumatology (ACR) SLE classification criteria, more than 2 visits, longer than 3 months of follow-up, and documented year of SLE diagnosis. DLE was confirmed by a dermatologist, supported by histopathology and images. SLE manifestations, medications, and serologies were collected. Multivariable-adjusted logistic regression analyses tested for associations between DLE and each of the ACR SLE criteria, and ESRD.

Results

A total of 1043 patients with SLE (117 with DLE and 926 without DLE) were included in the study. After multivariable adjustment, DLE in SLE was significantly associated with photosensitivity (odds ratio [OR] 1.63), leukopenia (OR 1.55), and anti-Smith antibodies (OR 2.41). DLE was significantly associated with reduced risks of arthritis (OR 0.49) and pleuritis (OR 0.56). We found no significant associations between DLE and nephritis or ESRD.

Limitations

Cross-sectional data collection with risk of data not captured from visits outside system was a limitation.

Conclusions

In our SLE cohort, DLE was confirmed by a dermatologist and we adjusted for possible confounding by medication use, in particular hydroxychloroquine. We found increased risks of photosensitivity, leukopenia, and anti-Smith antibodies and decreased risks of pleuritis and arthritis in patients with SLE and DLE. DLE was not related to anti-double-stranded DNA antibodies, lupus nephritis, or ESRD. These findings have implications for prognosis among patients with SLE.

Le texte complet de cet article est disponible en PDF.

Key words : cutaneous lupus erythematosus, discoid lupus erythematosus, epidemiology, prognosis, systemic lupus erythematosus

Abbreviations used : ACR, DLE, dsDNA, ESRD, OR, SLE


Plan


 Supported in part by National Institute of Arthritis and Musculoskeletal and Skin Diseases T32AR007530 and P60AR057782. The sponsors had no role in the design and conduct of the study; the collection, analysis, and interpretation of data; or the preparation, review, or approval of the manuscript.
 Conflicts of interest: None declared.


© 2013  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 69 - N° 1

P. 19-24 - juillet 2013 Retour au numéro
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