Determining risk factors for developing systemic lupus erythematosus in patients with discoid lupus erythematosus

Abstract

Up to 28% of patients with discoid lupus erythematosus (DLE) are susceptible to developing systemic lupus erythematosus (SLE). To better characterize patients with DLE who have a higher potential of developing SLE, we reviewed studies contrasting, firstly, DLE-only patients (i.e. patients with DLE without SLE) and SLE patients with DLE (i.e. patients who are diagnosed with SLE and DLE simultaneously, and patients with SLE who later develop DLE), and secondly, DLE-only patients and patients with DLE who progress to SLE. These studies have commonly identified various clinical and laboratory indicators, such as widespread DLE lesions, arthralgias/arthritis, nail changes, anaemia, leucopenia, high erythrocyte sedimentation rates (ESRs) and high titres of antinuclear antibodies (ANAs), which are associated with progression to SLE in patients with DLE, and SLE patients with DLE. Limitations of these studies include inadequate follow-up time, small numbers of patients with DLE converting to SLE, outdated criteria for SLE diagnosis and retrospective study designs. However, because of the risk of SLE development in patients with DLE, complete skin examinations, joint assessments and laboratory tests including ANA, ESR and full blood counts should be performed regularly for patients with DLE. A prospective study following patients with DLE who do or do not develop SLE is currently underway through the Cutaneous Lupus Registry at the University of Texas Southwestern Medical Center. It will seek to identify clinical features and biomarkers that improve our assessment of risk of systemic spread in these patients.

Cutaneous lupus erythematosus: Diagnosis and treatment

“…DLE occurs more frequently in women in their fourth and fifth decade of life [11]. Patients with DLE generally have a more benign disease course as compared to patients with other CLE subtypes, with only a reported 5-10% developing SLE throughout their disease course [28,29]. Studies have shown that patients with generalized DLE are more likely to progress to systemic disease, compared to patients with localized DLE [9,30].…”

The natural history of pediatric-onset discoid lupus erythematosus

“…18 However, adults with DLE who develop SLE often have mild clinical disease with infrequent neurologic and renal involvement. 14,19,20 Wieczorek et al 11 found that most patients with DLE were given the diagnosis of SLE by meeting mucocutaneous and laboratory criteria without development of end-organ damage.…”

“…[7][8][9][10] In adults, the frequency of progression of DLE to SLE is reported to range from 0% to 28%, with an interval between onset of DLE and SLE ranging from months to decades. [10][11][12][13][14] Lesions are further classified as localized (confined to the head and neck) or generalized (involving the entire body); this distinction may be clinically significant, as some studies in both adults and children have demonstrated a higher risk of SLE with generalized DLE. [15][16][17][18] Nephropathy, arthralgias, and elevated antinuclear antibody titers may also predict transformation to SLE in adults.…”

Discoid Lupus Erythematosus Complicated with Pregnancy-induced Hemophagocytic Syndrome

“…Up to 28% of patients with DLE develop SLE (10), while 0.9-2.4% of patients with SLE develop HPS (11). We initially suspected that our case progressed from DLE to SLE developing HPS.…”