• Joseph F Merola, Stephen D Prystowsky, Christina Iversen, Jose A Gomez-Puerta, Tabatha Norton, Peter Tsao, Elena Massarotti, Peter Schur, Bonnie Bermas, and Karen H Costenbader.
• Department of Medicine, Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02118, USA. jfmerola@partners.org
• J. Am. Acad. Dermatol. 2013 Jul 1; 69 (1): 19-24.

BackgroundCutaneous 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).ObjectiveWe sought to investigate associations between confirmed DLE and other SLE manifestations, adjusting for confounders.MethodsWe 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.ResultsA 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.LimitationsCross-sectional data collection with risk of data not captured from visits outside system was a limitation.ConclusionsIn 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.Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

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