title: Association of discoid lupus erythematosus with other clinical manifestations among patients with systemic lupus erythematosus.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02118, USA. jfmerola@partners.org
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Merola
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Prystowsky
authors.forename: Christina
authors.initials: C
authors.lastname: Iversen
authors.forename: Jose A
authors.initials: JA
authors.lastname: Gomez-Puerta
authors.forename: Tabatha
authors.initials: T
authors.lastname: Norton
authors.forename: Peter
authors.initials: P
authors.lastname: Tsao
authors.forename: Elena
authors.initials: E
authors.lastname: Massarotti
authors.forename: Peter
authors.initials: P
authors.lastname: Schur
authors.forename: Bonnie
authors.initials: B
authors.lastname: Bermas
authors.forename: Karen H
authors.initials: KH
authors.lastname: Costenbader
mesh_terms: D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008179:Lupus Erythematosus, Discoid / Q000453:epidemiology*; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology*; D008297:Male; D011379:Prognosis; D055815:Young Adult
references.citation: Medicine (Baltimore). 1976 Mar;55(2):183-91
references.pmid: 1082971
references.citation: Ann Rheum Dis. 2003 Jun;62(6):556-60
references.pmid: 12759294
references.citation: Arch Dermatol. 2012 May;148(5):651-5
references.pmid: 22782164
references.citation: Lupus. 2009 Dec;18(14):1267-75
references.pmid: 19861343
references.citation: J Am Acad Dermatol. 1985 Feb;12(2 Pt 1):278-88
references.pmid: 3871800
references.citation: Arch Dermatol. 1975 Nov;111(11):1448-52
references.pmid: 1081865
references.citation: Arthritis Rheum. 1997 Sep;40(9):1725
references.pmid: 9324032
references.citation: Clin Rheumatol. 1998;17(6):468-77
references.pmid: 9890674
references.citation: Arch Dermatol. 1982 Jun;118(6):412-6
references.pmid: 7092253
references.citation: Arthritis Rheum. 2005 Dec;52(12):4003-10
references.pmid: 16320348
references.citation: Arthritis Care Res (Hoboken). 2012 May;64(5):704-12
references.pmid: 22190480
references.citation: J Am Acad Dermatol. 1985 Nov;13(5 Pt 1):748-55
references.pmid: 3878371
references.citation: J Drugs Dermatol. 2011 Dec;10(12):1413-20
references.pmid: 22134565