Association of discoid lupus erythematosus with clinical manifestations and damage accrual in a multiethnic lupus cohort

Abstract

Objective To determine the clinical manifestations and disease damage associated with discoid rash in a large multiethnic systemic lupus erythematosus (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. 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 women. Discoid lupus was observed in 393 (17.6%) of patients with SLE. In the multivariable analysis, patients with discoid lupus were more likely to be smokers and of African-American ethnicity, and to have malar rash, photosensitivity, oral ulcers, leukopenia and vasculitis. DLE patients were less likely to be of Hispanic (from Texas) ethnicity, and to have arthritis, end-stage renal disease (ESRD), and antinuclear, anti-dsDNA and anti-phospholipid antibodies. Patients with DLE had more damage accrual, particularly chronic seizures, scarring alopecia, scarring of the skin, and skin ulcers. Conclusion In this cohort of SLE patients, discoid lupus was associated with several clinical features including serious manifestations such as vasculitis and chronic seizures.

Natural history of disease activity and damage in patients with cutaneous lupus erythematosus

“…11 In another study, it was found that among the different CLE subtypes, patients with DLE were noted to have greater degrees of disease damage due to dyspigmentation and scarring. 12 Smoking is associated with CLE in general, especially DLE, 13 and smokers with CLE tend to have greater disease activity than nonsmokers. 14 In a recent study by Kuhn et al, 15 the total CLASI activity and damage scores of patients with CLE was higher in those who had ever smoked than in nonsmokers.…”

Multisystemic diseases and ethnicity: a focus on lupus erythematosus, systemic sclerosis, sarcoidosis and Behçet disease

“…3 In a large multiethnic cohort of SLE, DLE, arthritis and terminal renal failure were negatively associated with Hispanic, but positively associated with African-American populations. 6 Another study demonstrated a positive association of antiphospholipid antibodies in 'Aboriginal' Canadians with SLE, compared with persons of Asian or European descent. 7 Our anecdotal experience indicates that discoid lesions (either isolated or in the setting of SLE), are more severe in nonwhite individuals; however, this has not as yet been confirmed by published studies in persons of African descent.…”

Evaluation of the Incidence of Discoid Lupus Erythematosus in Patients with Systemic Lupus Erythematosus and Its Relationship to Disease Activity

“…In a longitudinal cohort study conducted on 2,228 SLE patients, Santiago-Casas and colleagues demonstrated that DLE patients were more likely to be African-American with malar rash, photo sensitivity, oral ulcers, leukopenia, and vasculitis. 19 Despite the rather small group under investigation, which is obviously our chief limitation, this study provides an acceptable comparison of two groups of patients with SLE.…”