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Original Article
Available online 9 May 2023
Cutaneous manifestations in patients with systemic lupus erythematosus: Forms at the beginning of the disease and during follow-up. Retrospective analysis
Manifestaciones cutáneas en pacientes con lupus eritematoso sistémico: formas al inicio de la enfermedad y durante el seguimiento. Análisis retrospectivo
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Máximo Cosentino
Corresponding author
maxic_330@hotmail.com

Corresponding author.
, María Victoria Martire, Lucila García, Mercedes Argentina García
Servicio de Reumatología, Hospital Interzonal General de Agudos San Martín, La Plata, Buenos Aires, Argentina
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Received 22 April 2022. Accepted 04 November 2022
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Tables (3)
Table 1. Demographic data, comorbidities and antibody profile of all the patients.
Table 2. Types and frequency of skin involvement at disease onset.
Table 3. Factors associated with skin involvement at disease onset. Bivariate analysis and logistic regression.
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Abstract
Objectives

To describe skin involvement (SI) in patients with systemic lupus erythematosus (SLE) at onset and during follow-up of the disease and to determine factors associated with SI at lupus diagnosis.

Materials and methods

Retrospective, observational, and descriptive study, from a single centre in patients diagnosed with SLE (ACR 1982-97 or SLICC 2012 criteria). The modified Gilliam classification for SI was used. Descriptive statistics and bivariate and multivariate analysis were performed to evaluate the factors associated with SI at diagnosis of the disease.

Results

149 patients were included, 91.3% women with a median age at diagnosis of 33 years. SI at onset of the disease occurred in 125 patients (83.9%), followed by joint involvement in 120 cases (80.5%). Non-specific skin lesions were more frequent than specific lesions, 92.8% versus 66.4%, respectively. In the bivariate analysis, a longer delay to diagnosis, the presence of joint involvement, a lower presence of thrombocytopenia, and a higher SLEDAI-2K score were associated with the presence of SI at onset of the disease. In the multivariate analysis, the variable that remained independently associated was joint involvement (OR 2.8%–95% CI 1.1–7.5, p: .04). During follow-up, 4/24 patients who had not presented SI at diagnosis and 51/125 patients who had, had at least one new skin flare (range: 1–5 outbreaks).

Conclusions

Our study demonstrates the high frequency of skin involvement in SLE, both diagnostically and evolutionarily, and confirms previously reported data regarding the existence of a skin-articular phenotype.

Keywords:
Systemic lupus erythematosus
Skin involvement
Gilliam classification
Joint involvement
Resumen
Objetivo

Describir el compromiso cutáneo (CC) en pacientes con lupus eritematoso sistémico (LES) al inicio de la enfermedad y durante el seguimiento. Determinar factores asociados a dicho compromiso al comienzo de la enfermedad.

Materiales y métodos

Estudio retrospectivo, observacional y descriptivo, de centro único, en pacientes con diagnóstico de LES (ACR 97 o SLICC 2012). Se utilizó la clasificación de Gilliam modificada para el CC. Se realizó estadística descriptiva; y análisis bivariado y multivariado para evaluar los factores asociados al compromiso cutáneo.

Resultados

Se incluyeron 149 pacientes, 91.3% mujeres con una mediana de edad al diagnóstico 33 años. El CC al inicio de la enfermedad ocurrió en 125 pacientes (83.9%), seguido por compromiso articular en 120 (80.5%). Las lesiones no específicas fueron más frecuentes que las específicas, 92.8% versus 66.4%, respectivamente. En el análisis bivariado, la mayor demora al diagnóstico, la presencia de compromiso articular, menor presencia de trombocitopenia y mayor puntuación de SLEDAI-2 K se asociaron con la presencia de CC al inicio de la enfermedad. En el análisis multivariado, la variable que se mantuvo asociada de manera independiente fue el compromiso articular (OR 2.8, IC 95% 1.1–7.5, p: 0.04). Durante el seguimiento, 4/24 pacientes que no habían presentado CC al diagnóstico y 51/125 pacientes que sí lo presentaron, tuvieron al menos un nuevo episodio cutáneo (rango: 1–5 brotes).

Conclusiones

Nuestro estudio demuestra la alta frecuencia de pacientes que presenta compromiso cutáneo en el LES, tanto en el diagnóstico como evolutivamente, y confirma los datos reportados previamente en cuanto a la existencia de un fenotipo cutáneo-articular.

Palabras clave:
Lupus eritematoso sistémico
Compromiso cutáneo
Clasificación de Gilliam
Compromiso articular

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