SLE患者出现DLE皮损可能预示着疾病的病程

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提示:最新的研究发现,SLE患者出现DLE皮损可能预示着疾病的病程。

DLE

盘状红斑狼疮Discoid lupus erythematosus,DLE)特点为皮肤持久性盘状红斑,境界清楚,表现毛细血管扩张并有粘着性鳞屑,剥离鳞屑,可见其下扩张的毛囊口。好发于面部,特别是两颊及鼻背,呈蝶形分布。其次发生于口唇,耳廓,头皮等处。也可泛发。另外可见紫红色荨麻疹样斑块,不发生萎缩和鳞屑,一般在面部,可不对称。

SLE

系统性红斑狼疮systemic lupus erythematosusSLE)是累及多系统性的自身免疫性疾病,其皮疹多形性,可表现为面部蝶形红斑,慢性盘状狼疮皮损,眶周水肿带紫红色和毛细血管扩张,手足部皮损,血管炎皮损,紫癜,网状青斑,慢性荨麻疹,雷诺现象,光感性皮炎,脱发,狼疮发,黏膜损害等。

SLE出现DLE皮损预示疾病进展

过去认为DLE红斑狼疮中病情相对较轻的一型,是红斑狼疮中的良性型。相较于SLE而言,不累及内脏器官,关节症状少见。因为DLE的诊断主要相较SLE比较容易,Merola JF等猜测是还否可以通过DLE预示SLE疾病进展。

为了验证这一假设,Merola JF和他的团队进行了一项多中心的回顾性研究。共有1043名SLE患者,所有的患者均符合ACR诊断标准。这些患者分成两组,有DLE者(n=117)和无DLE者(n=926)。Merola JF等然后看DLE是否增加或减少其它SLE表现如肾病的可能性。

最后的数据分析结果如下
  1. 同时伴DLE皮损者光敏感(OR=1.63),白细胞减少症(OR=1.55)和抗Sm抗体出现频率(OR=2.41)风险增加;
  2. 同时伴有DLE皮损者胸膜炎(OR=0.56)和关节炎(OR=0.49)风险减少;
  3. 同时伴有DLE并未增加肾病及肾衰,神经系统疾病,心包炎和抗磷脂抗体风险。

结论

SLE表现千变万化,患者皮肤症状多形性,系统表现多种多样。很多研究多着重于临床症状和血液学检查来提示疾病的严重程度。本研究表明,SLE如同时伴有DLE皮损很少会发展成肾病的可能。同时,本研究也未发现DLE与肾病之间有阳性或者阴性的联系。

本研究的结果表明,如果患者患有DLE,他们伴有关节炎和肾病的可能性较小,但是光敏感和白细胞减少的可能性就大。

Association of discoid lupus erythematosus with other clinical manifestations among patients with systemic lupus erythematosus.

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.

LIMITATIONS:

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.
Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

参考文献

  1. To CH, Mok CC, Tang SS, Ying SK, Wong RW, Lau CS. Prognostically distinct clinical patterns of systemic lupus erythematosus identified by cluster analysis. Lupus. 2009;18:1267-1275.
  2. Merola JF, Chang CA, Sanchez MR, Prystowsky SD. Is chronic cutaneous discoid lupus protective against severe renal disease in patients with systemic lupus erythematosus? J Drugs Dermatol. 2011;10:1413-1420.
  3. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.
  4. Callen JP. Systemic lupus erythematosus in patients with chronic cutaneous (discoid) lupus erythematosus. Clinical and laboratory findings in seventeen patients. J Am Acad Dermatol. 1985;12:278-288.

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