Clinical and Immunologic Profiles in Incomplete Lupus Erythematosus and Improvement with Hydroxychloroquine Treatment

Abstract

Objective. The study goals were to evaluate performance of SLE classification criteria, to define patients with incomplete lupus erythematosus (ILE), and to probe for features in these patients that might be useful as indicators of disease status and hydroxychloroquine response. Methods. Patients with ILE (N = 70) and SLE (N = 32) defined by the 1997 American College of Rheumatology criteria were reclassified using the 2012 Systemic Lupus International Collaborating Clinics criteria. Disease activity, patient reported outcomes, and levels of Type I interferon- (IFN-) inducible genes, autoantibodies, and cytokines were measured. Subgroups treated with hydroxychloroquine (HCQ) were compared to patients not on this drug. Results. The classification sets were correlated (R2 = 0.87). ILE patients were older (P = 0.0043) with lower disease activity scores (P < 0.001) and greater dissatisfaction with health status (P = 0.034) than SLE patients. ILE was associated with lower levels of macrophage-derived cytokines and levels of expressed Type I IFN-inducible genes. Treatment of ILE with HCQ was associated with better self-reported health status scores and lower expression levels of Type I IFN-inducible genes than ILE patients not on HCQ. Conclusion. The 2012 SLICC SLE classification criteria will be useful to define ILE in trials. Patients with ILE have better health status and immune profiles when treated with HCQ.

Incomplete Systemic Lupus Erythematosus: What Remains After Application of American College of Rheumatology and Systemic Lupus International Collaborating Clinics criteria?

“…Most publications on iSLE are based on patients with clinical features of SLE who do not fulfill ACR criteria (3), and only some studies use the SLICC criteria. Table shows an overview of these studies .…”

Mock Recruitment for the Study of Antimalarials in an Incomplete Lupus Erythematosus Trial

“…Clinically, the features of SLE can be present over several years before formal classification is possible. This has given rise to the term incomplete lupus erythematosus (ILE), which may be used to refer to individuals with clinical or serologic features of lupus who are progressing to incident SLE, as well as individuals who never develop the requisite number of criteria for formal classification ().…”

“…However, HCQ has not been rigorously tested in patients with ILE. While a recent study showed that ILE patients taking HCQ had lower expression levels of type I interferon‐inducible genes than those not taking the drug, the long‐term clinical benefit of this medication is unknown ().…”

Immunoinflammatory Rheumatic Diseases Associated With Type I Interferon: New Evidence

“…2). Следует подчеркнуть, что стандартная терапия ИВРЗ базисными противовоспалительными препаратами (БПВП), в первую очередь ГК и гидроксихлорохином (ГХ), подавляет экспрессию ISGs при СШ [82], первичном антифосфолипидном синдроме [75], подострой кожной волчанке [83], «неполной» красной волчанке [84]. В связи с этим представляют интерес данные, касающиеся дефектов клеточной регуляции синтеза ИФНα при ИВРЗ, которые потенциально могут рассматриваться в контексте механизмов действия БПВП [22].…”