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Lupus. 2017 Jan;26(1):73-83. Epub 2016 May 26.

Early discoid lupus erythematosus protects against renal disease in patients with systemic lupus erythematosus: longitudinal data from a large Latin American cohort.

Author information

1
Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Barcelona, Spain.
2
Department of Dermatology, Emory School of Medicine, Atlanta, USA.
3
Division of Rheumatology, Emory School of Medicine, Atlanta, USA.
4
Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina.
5
GLADEL Consultant, Universidad Nacional de Rosario, Rosario, Argentina.
6
Servicio de Reumatología, Hospital Privado, Córdoba, Argentina.
7
Departamento de Medicina, Universidade Federal da São Paulo (UNIFESP), São Paulo, Brazil.
8
Sección de Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
9
Fundación Dr Pedro M Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.
10
Divisao de Reumatologia, Universidade Estadual de Campinas, Campinas, Brazil.
11
Sección de Reumatología, Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
12
Facultad de Medicina, Universidad Nacional de Colombia, Bogota, Colombia.
13
Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba.
14
Centro de Investigación Clínica de Morelia, Morelia, México.
15
Servicio de Reumatología, Hospital Nacional 'Guillermo Almenara Irigoyen', School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Perú.
16
Servicio de Reumatología, Hospital Universitario, Caracas, Venezuela.
17
Division of Rheumatology, Emory School of Medicine, Atlanta, USA cdrenka@emory.edu.

Abstract

OBJECTIVES:

The objective of this study was to examine whether early discoid lupus erythematosus (DLE) would be a protective factor for further lupus nephritis in patients with systemic lupus erythematosus (SLE).

METHODS:

We studied SLE patients from GLADEL, an inception longitudinal cohort from nine Latin American countries. The main predictor was DLE onset, which was defined as physician-documented DLE at SLE diagnosis. The outcome was time from the diagnosis of SLE to new lupus nephritis. Univariate and multivariate survival analyses were conducted to examine the association of DLE onset with time to lupus nephritis.

RESULTS:

Among 845 GLADEL patients, 204 (24.1%) developed lupus nephritis after SLE diagnosis. Of them, 10 (4.9%) had DLE onset, compared to 83 (12.9%) in the group of 641 patients that remained free of lupus nephritis (hazard ratio 0.39; P = 0.0033). The cumulative proportion of lupus nephritis at 1 and 5 years since SLE diagnosis was 6% and 14%, respectively, in the DLE onset group, compared to 14% and 29% in those without DLE (P = 0.0023). DLE onset was independently associated with a lower risk of lupus nephritis, after controlling for sociodemographic factors and disease severity at diagnosis (hazard ratio 0.38; 95% confidence interval 0.20-0.71).

CONCLUSIONS:

Our data indicate that DLE onset reduces the risk of further lupus nephritis in patients with SLE, independently of other factors such as age, ethnicity, disease activity, and organ damage. These findings have relevant prognosis implications for SLE patients and their clinicians. Further studies are warranted to unravel the biological and environmental pathways associated with the protective role of DLE against renal disease in patients with SLE.

KEYWORDS:

GLADEL cohort; Systemic lupus erythematosus; discoid lupus erythematosus; lupus nephritis; survival analysis

PMID:
27230554
DOI:
10.1177/0961203316651740
[Indexed for MEDLINE]

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