title: Possible protective effect of hydroxychloroquine on delaying the occurrence of integument damage in lupus: LXXI, data from a multiethnic cohort.
abstract: OBJECTIVE
  To determine the features predictive of time to integument damage in patients with systemic lupus erythematosus (SLE) from a multiethnic cohort (LUpus in MInorities, NAture versus nurture [LUMINA]).
  
  
  METHODS
  LUMINA SLE patients (n = 580) age > or =16 years, with a disease duration of < or =5 years at baseline (T0), of African American, Hispanic, and Caucasian ethnicity were studied. Integument damage was defined per the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (scarring alopecia, extensive skin scarring, and skin ulcers lasting at least 6 months); factors associated with time to its occurrence were examined by Cox proportional univariable and multivariable (main model) hazards regression analyses. Two alternative models were also examined: in model 1, all patients, regardless of when integument damage occurred (n = 94), were included; in model 2, a time-varying approach (generalized estimating equation) was employed.
  
  
  RESULTS
  Thirty-nine (6.7%) of 580 patients developed integument damage over a mean +/- SD total disease duration of 5.9 +/- 3.7 years, and were included in the main multivariable regression model. After adjusting for discoid rash, nailfold infarcts, photosensitivity, and Raynaud's phenomenon (significant in the univariable analyses), disease activity over time (hazard ratio [HR] 1.17, 95% confidence interval [95% CI] 1.09-1.26) was associated with a shorter time to integument damage, whereas hydroxychloroquine use (HR 0.23, 95% CI 0.12-0.47) and Texan-Hispanic (HR 0.35, 95% CI 0.14-0.87) and Caucasian ethnicities (HR 0.37, 95% CI 0.14-0.99) were associated with a longer time. Results of the alternative models were consistent with those of the main model, although in model 2, the association with hydroxychloroquine was not significant.
  
  
  CONCLUSIONS
  Our data indicate that hydroxychloroquine use is possibly associated with a delay in integument damage development in patients with SLE.
authors.affiliation: University of Alabama at Birmingham, USA.
authors.forename: Guillermo J
authors.initials: GJ
authors.lastname: Pons-Estel
authors.forename: Graciela S
authors.initials: GS
authors.lastname: Alarcón
authors.forename: Luis A
authors.initials: LA
authors.lastname: González
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.forename: Luis M
authors.initials: LM
authors.lastname: Vilá
authors.forename: John D
authors.initials: JD
authors.lastname: Reveille
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
mesh_terms: D000328:Adult; D001741:Black or African American; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D012871:Skin Diseases / Q000150:complications / Q000208:ethnology / Q000517:prevention & control*; D044465:White People; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D006886:Hydroxychloroquine
references.citation: J Rheumatol. 2003 Jul;30(7):1513-9
references.pmid: 12858450
references.citation: Arthritis Rheum. 2001 Dec;44(12):2797-806
references.pmid: 11762940
references.citation: Lupus. 2007;16(12):997-1000
references.pmid: 18042596
references.citation: Lupus. 2002;11(6):356-61
references.pmid: 12139373
references.citation: Lupus. 2007;16(2):89-94
references.pmid: 17402364
references.citation: Arthritis Rheum. 1989 Sep;32(9):1107-18
references.pmid: 2775320
references.citation: Arthritis Rheum. 1990 Feb;33(2):281-6
references.pmid: 2306296
references.citation: J Rheumatol. 2003 Sep;30(9):1955-9
references.pmid: 12966597
references.citation: Lupus. 2003;12(10):788-94
references.pmid: 14596430
references.citation: Am J Epidemiol. 2008 May 1;167(9):1120-9
references.pmid: 18334500
references.citation: Thromb Haemost. 1993 Nov 15;70(5):787-93
references.pmid: 8128436
references.citation: J Clin Epidemiol. 2006 May;59(5):437-47
references.pmid: 16632131
references.citation: J Psychosom Res. 1993 Jan;37(1):53-62
references.pmid: 8421260
references.citation: Medicine (Baltimore). 2006 Jul;85(4):221-228
references.pmid: 16862047
references.citation: J Invest Dermatol. 2005 Nov;125(5):889-94
references.pmid: 16297185
references.citation: Acta Derm Venereol. 1995 May;75(3):228-31
references.pmid: 7653184
references.citation: Am J Clin Pathol. 1990 Oct;94(4):476-84
references.pmid: 2220676
references.citation: Rheumatology (Oxford). 2009 Jun;48(6):673-5
references.pmid: 19359343
references.citation: Ann Rheum Dis. 2007 Sep;66(9):1168-72
references.pmid: 17389655
references.citation: Arthritis Rheum. 2005 May;52(5):1473-80
references.pmid: 15880829
references.citation: Lupus. 1998;7(2):80-5
references.pmid: 9541091
references.citation: Arthritis Rheum. 1996 Mar;39(3):363-9
references.pmid: 8607884
references.citation: Br J Med Psychol. 1997 Jun;70 ( Pt 2):113-47
references.pmid: 9210990
references.citation: Arthritis Rheum. 2007 Aug 15;57(6):993-9
references.pmid: 17665464
references.citation: Arthritis Rheum. 1997 Sep;40(9):1725
references.pmid: 9324032
references.citation: J Rheumatol. 2000 Mar;27(3):680-4
references.pmid: 10743808
references.citation: J Rheumatol. 1998 Sep;25(9):1716-9
references.pmid: 9733451
references.citation: Arthritis Rheum. 1988 Apr;31(4):496-505
references.pmid: 2451920
references.citation: Arthritis Rheum. 1982 Nov;25(11):1271-7
references.pmid: 7138600
references.citation: Lupus. 2002;11(3):152-60
references.pmid: 12004788
references.citation: Rheumatology (Oxford). 2001 Jan;40(1):37-47
references.pmid: 11157140
references.citation: Lupus. 2006;15(8):532-40
references.pmid: 16942007
references.citation: Rheumatol Int. 2007 Mar;27(5):483-7
references.pmid: 17033832
references.citation: Clin Rheumatol. 2005 Aug;24(4):377-80
references.pmid: 15599643
references.citation: Lupus. 1999;8(3):197-209
references.pmid: 10342712
references.citation: Semin Cutan Med Surg. 1998 Sep;17(3):219-27
references.pmid: 9759680
references.citation: N Engl J Med. 1991 Jan 17;324(3):150-4
references.pmid: 1984192
references.citation: J Am Acad Dermatol. 2006 Sep;55(3):490-500
references.pmid: 16908356
references.citation: Rheumatology (Oxford). 2004 Mar;43(3):358-63
references.pmid: 14623949
references.citation: Ann N Y Acad Sci. 1975 Jun 30;254:505-15
references.pmid: 52321