SLE patients with discoid lupus erythematosus at risk for other clinical manifestations

Patients who had discoid lupus erythematosus and systemic lupus erythematosus were at increased risk for photosensitivity, leukopenia and anti-Smith antibodies and decreased risk for pleuritis and arthritis, according to study results.

Joseph F. Merola, MD, instructor at Harvard Medical School and director of Clinical Trials, Dermatology, at Brigham and Women’s Hospital in Boston, and fellow researchers reviewed electronic records of the Brigham and Women’s Hospital Lupus Registry to identify 1,043 patients with systemic lupus erythematosus (SLE; mean age at diagnosis, 32 years; 92% women). Rheumatologist confirmation based on 1997 American College of Rheumatology (ACR) SLE classification criteria, more than two office visits, more than 3 months of follow-up and the documented year of SLE diagnosis were inclusion criteria. A dermatologist confirmed discoid lupus erythematosus (DLE) in 117 patients through histopathology and images.

Merola_Joseph_F 

Joseph F. Merola

Associations between DLE and ACR SLE criteria, and end-stage renal disease (ESRD) were tested through multivariable adjusted logistic regression analysis. Photosensitivity (OR=1.63; 95% CI, 1.09-2.44), leukopenia (OR=1.55; 95% CI, 1.03-2.32) and anti-Smith antibodies (OR=2.41; 95% CI, 1.58-3.69) were significantly associated with DLE in SLE.

Reduced risks for arthritis (OR=0.49; 95% CI, 0.31-0.76) and pleuritis (OR=0.56; 95% CI, 0.36-0.87) also were significantly associated with DLE after adjustment, while lupus nephritis or ESRD displayed no significant association.

“Prior studies have suggested that among patients with SLE, the presence of DLE in these patients was a marker of less severe disease, particularly associated with less nephritis, and was often offered as reassurance to the patient,” Merola told Healio.com. “We did not observe this association with nephritis or disease severity in our large lupus registry. We did find a few interesting associations among SLE patients, demonstrating that those with DLE had an increased association with anti-smith antibodies, leukopenia and photosensitivity, while they had a decreased association with serositis and arthritis. These findings have important implications for counseling our patients with SLE and DLE regarding prognosis.”