Cutaneous vasculitis in systemic lupus erythematosus patients: potential key players and implications

Abstract

Objectives The aim of the present work was to study the clinical characteristics of cutaneous vasculitis (CV) in systemic lupus erythematosus (SLE) patients and find possible potential key players in its development and implicated associations with the disease manifestations. Patients and methods Fifty adult female SLE patients underwent full history taking, thorough clinical examination and laboratory investigations. The SLE Disease Activity Index (SLEDAI) and accumulated damage using the Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI) were assessed. Results The mean age of the patients was 29.1 ± 6.1 years and was significantly lower in those with CV ( p = 0.018). The disease duration was 4.9 ± 3.7 years. CV was present in 30% of the patients. Musculoskeletal manifestations and hypocomplementemia were present in all patients with CV. The SLEDAI and SLICC/ACR DI tended to be higher in those with CV. Complement (C3 and C4) was significantly consumed in CV patients ( p < 0.0001). Antiphospholipids were comparable between those with and without CV. Lupus nephritis, cardiovascular manifestations and Sjögren syndrome were significantly linked to the development of CV ( p = 0.025, p = 0.023 and p < 0.0001, respectively). Both C3 and C4 showed a high sensitivity (93.3% and 86.7%) to detect CV in SLE at cut-off values below 81.4 mg/dl and 16.8 mg/dl, respectively. Conclusion CV is closely related to hypocomplementemia but not to antiphospholipids and is associated with lupus nephritis, musculoskeletal manifestations and Sjögren syndrome.

Cutaneous vasculitis in SLE

“…A small retrospective study of 50 patients with SLE in Egypt found an association between combined mucocutaneous manifestations and cutaneous vasculitis. 7 Haematological manifestations such as anaemia, direct Coombs' positivity and leucopenia were found to be risk factors for developing cutaneous vasculitis in our study. Gheita et al 7 had also reported an association between anaemia and cutaneous vasculitis.…”

“…16 A retrospective analysis of 171 juvenile patients with SLE of Asian descent found an increased risk of renal and neuropsychiatric manifestations in patients who have cutaneous vasculitis compared with those who did not. 1 Gheita et al 7 had reported an association between cutaneous vasculitis and lupus nephritis in a small retrospective study from Egypt evaluating 50 adult patients with SLE. Our study, the largest overall and the only one with long follow-up, did not show any association between cutaneous vasculitis and CNS or renal lupus.…”

“…17 One study of patients with SLE reported an association with hypocomplementaemia and antiphospholipid syndrome. 7 The aim of this study was to determine the association between clinical and serological manifestations of SLE and development of future cutaneous small vessel vasculitis, as well as the association between the presence of cutaneous vasculitis and organ damage in a large prospective multiethnic cohort.…”

“…One study of juvenile SLE patients with cutaneous vasculitis alone found that it was associated with more seizures and granular casts. 1 In adult patients with SLE, having cutaneous vasculitis was associated with Raynaud’s phenomenon, 15 mucocutaneous and musculoskeletal manifestations, 7 myositis 1 or no major organ involvement. 15 Cutaneous vasculitis was also found to correlate with disease activity 1 5 7 16 and poor prognosis with renal system and central nervous system (CNS) deterioration.…”

“… 17 One study of patients with SLE reported an association with hypocomplementaemia and antiphospholipid syndrome. 7 …”