Risk Factors of Progression From Discoid Lupus to Severe Systemic Lupus Erythematosus

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• In this retrospective cohort study of 164 patients with discoid lupus erythematosus (DLE), 18% developed manifestations of severe systemic lupus erythematosus (SLE). The following factors predicted the development of SLE: age at DLE diagnosis <25 years, antinuclear antibodies (ANA) titers ≥1:320, and skin phototype V or VI. The authors created a scoring system with these three factors to predict the risk of SLE and help guide monitoring.
• A younger age at DLE diagnosis, a high ANA titer, and skin phototype V or VI are risk factors for the progression of DLE to severe SLE.

–  Katherine M. Stiff, MD

Abstract

BACKGROUND

No study assessed risk factors of progression from discoid lupus erythematosus (DLE) to severe systemic lupus erythematosus (sSLE) (defined as requiring hospitalization and specific treatment).

OBJECTIVE

To identify risks factors and generate a predicting score of progression to sSLE among patients with isolated DLE or associated with SLE with mild biological abnormalities.

METHODS

In this registry-based cohort study, multivariable analysis was performed using risk factors identified from literature and pruned by backward selection to identify the relevant variables. The number of points was weighted proportionally to the odds-ratio.

RESULTS

We included 30 DLE who developed sSLE and 134 who did not. In multivariable analysis, among 12 selected variables, age at DLE diagnosis <25 years (OR=2.8 [95% CI: 1.1-7.0], 1 point), phototype V-VI (OR=2.7 [95% CI: 1.1-7.0], 1 point) and Antinuclear antibodies (ANA) titers ≥1:320 (OR=15 [95% CI: 3.3-67.3], 5 points) were selected to generate the score. Among the 54 patients with a score of 0 at baseline, none progressed to sSLE while a score ≥ 6 was associated with a risk of ≈40%.

LIMITATIONS

Retrospective design.

CONCLUSION

In our cohort, age at DLE diagnosis <25 years, phototype V-VI and ANA titers ≥1:320 were risk factors of developing sSLE.

Journal of the American Academy of Dermatology

Risk factors of progression from discoid lupus to severe systemic lupus erythematosus: a registry-based cohort study of 164 patients

J Am Acad Dermatol 2022 Sep 22;[EPub Ahead of Print], L Fredeau, DS Courvoisier, RA Mehdi, S Ingen-Housz-Oro, E Mahe, N Costedoat-Chalumeau, L Arnaud, C Francès, A Mathian, M Jachiet, Z Amoura, JD Bouaziz, F Chasset 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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