title: Prognostic implications of active discoid lupus erythematosus and malar rash at the time of diagnosis of systemic lupus erythematosus: Results from a prospective cohort study.
abstract: OBJECTIVE
  Cutaneous lupus erythematosus (CLE) may have prognostic implications for systemic lupus erythematosus (SLE). We aimed to determine the impact of discoid lupus erythematosus (DLE) and malar rash on SLE disease activity.
  
  
  METHODS
  Data were analyzed from the Toronto Lupus Clinic prospective cohort study. We compared SLE patients with active DLE or malar rash at SLE diagnosis to SLE patients who never developed CLE. Outcomes were assessed at one and five years, including Adjusted Mean Systemic Lupus Erythematosus Disease Activity Index 2000 (AMS).
  
  
  RESULTS
  A total of 524 SLE patients (284 without CLE, 65 with DLE, and 175 with malar rash) were included. Mean AMS scores in patients without CLE at one and five years were 5.96 ± 5.06 and 4.00 ± 3.52, which did not differ significantly from scores at one (6.93 ± 5.31, p = 0.17) and five years (4.29 ± 2.62, p = 0.63) in the DLE group. In patients with malar rash, AMS scores at one (8.30 ± 6.80, p < 0.001) and five years (5.23 ± 3.06, p = 0.004) were higher than controls without CLE.
  
  
  CONCLUSIONS
  Malar rash may be a marker of more severe systemic disease over time, while DLE has no significant impact on general SLE disease activity.
authors.affiliation: Division of Dermatology, University Health Network, Toronto Western Hospital, Toronto, Canada aaron.drucker@utoronto.ca.
authors.forename: A M
authors.initials: AM
authors.lastname: Drucker
authors.affiliation: Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital, Toronto, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Su
authors.affiliation: Division of Dermatology, University of Toronto, Toronto, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Mussani
authors.affiliation: Division of Dermatology, University Health Network, Toronto Western Hospital, Toronto, Canada.
authors.forename: S K
authors.initials: SK
authors.lastname: Siddha
authors.affiliation: Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital, Toronto, Canada.
authors.forename: D D
authors.initials: DD
authors.lastname: Gladman
authors.affiliation: Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital, Toronto, Canada.
authors.forename: M B
authors.initials: MB
authors.lastname: Urowitz
mesh_terms: D000328:Adult; D018450:Disease Progression; D005076:Exanthema / Q000175:diagnosis* / Q000276:immunology; D005148:Facial Dermatoses / Q000175:diagnosis* / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008179:Lupus Erythematosus, Discoid / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D008181:Lupus Nephritis / Q000175:diagnosis / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: Systemic lupus erythematosus; cohort study; cutaneous lupus erythematosus; discoid lupus erythematosus; lupus nephritis; malar rash; prognosis