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Denvir B, Carlucci PM, Corbitt K, Buyon JP, Belmont HM, Gold HT, Salmon JE, Askanase A, Bathon JM, Geraldino-Pardilla L, Ali Y, Ginzler EM, Putterman C, Gordon C, Barbour KE, Helmick CG, Parton H, Izmirly PM. Prevalence of concomitant rheumatologic diseases and autoantibody specificities among racial and ethnic groups in SLE patients. FRONTIERS IN EPIDEMIOLOGY 2024; 4:1334859. [PMID: 38516120 PMCID: PMC10956350 DOI: 10.3389/fepid.2024.1334859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
Objective Leveraging the Manhattan Lupus Surveillance Program (MLSP), a population-based registry of cases of systemic lupus erythematosus (SLE) and related diseases, we investigated the proportion of SLE with concomitant rheumatic diseases, including Sjögren's disease (SjD), antiphospholipid syndrome (APLS), and fibromyalgia (FM), as well as the prevalence of autoantibodies in SLE by sex and race/ethnicity. Methods Prevalent SLE cases fulfilled one of three sets of classification criteria. Additional rheumatic diseases were defined using modified criteria based on data available in the MLSP: SjD (anti-SSA/Ro positive and evidence of keratoconjunctivitis sicca and/or xerostomia), APLS (antiphospholipid antibody positive and evidence of a blood clot), and FM (diagnosis in the chart). Results 1,342 patients fulfilled SLE classification criteria. Of these, SjD was identified in 147 (11.0%, 95% CI 9.2-12.7%) patients with women and non-Latino Asian patients being the most highly represented. APLS was diagnosed in 119 (8.9%, 95% CI 7.3-10.5%) patients with the highest frequency in Latino patients. FM was present in 120 (8.9%, 95% CI 7.3-10.5) patients with non-Latino White and Latino patients having the highest frequency. Anti-dsDNA antibodies were most prevalent in non-Latino Asian, Black, and Latino patients while anti-Sm antibodies showed the highest proportion in non-Latino Black and Asian patients. Anti-SSA/Ro and anti-SSB/La antibodies were most prevalent in non-Latino Asian patients and least prevalent in non-Latino White patients. Men were more likely to be anti-Sm positive. Conclusion Data from the MLSP revealed differences among patients classified as SLE in the prevalence of concomitant rheumatic diseases and autoantibody profiles by sex and race/ethnicity underscoring comorbidities associated with SLE.
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Affiliation(s)
- Brendan Denvir
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Philip M. Carlucci
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Kelly Corbitt
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Jill P. Buyon
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - H. Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Heather T. Gold
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Jane E. Salmon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Anca Askanase
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, United States
| | - Joan M. Bathon
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, United States
| | - Laura Geraldino-Pardilla
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, United States
| | - Yousaf Ali
- Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ellen M. Ginzler
- Division of Rheumatology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | | | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Kamil E. Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Charles G. Helmick
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hilary Parton
- Division of Disease Control, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, NY, United States
| | - Peter M. Izmirly
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
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2
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Heinly B, Allenzara A, Helm M, Foulke GT. Cutaneous Lupus Erythematosus: Review and Considerations for Older Populations. Drugs Aging 2024; 41:31-43. [PMID: 37991658 DOI: 10.1007/s40266-023-01079-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/23/2023]
Abstract
Though more common earlier in life, increasing attention is being focused on the development of cutaneous lupus erythematosus (CLE) in patients with advancing age. Studies show that CLE is more common in older populations than previously thought, and all CLE subtypes are possible in this group. Just like patients in the third or fourth decade of life, CLE may appear alongside or independent of systemic lupus erythematosus. Older populations manifesting CLE for the first time seem to have a lower risk of progression to systemic disease than younger peers, and are more commonly White. CLE must be carefully distinguished from other skin conditions that have a predilection for presentation in older populations, including rosacea, lichen planus, and other autoimmune conditions such as dermatomyositis or pemphigus/pemphigoid. It is thought that most CLE in older populations is drug-induced, with drug-induced subacute cutaneous lupus erythematosus being the most common subtype. Management of CLE in older patients focuses on eliminating unnecessary medications known to induce CLE, and otherwise treatment proceeds similarly to that in younger patients, with a few special considerations.
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Affiliation(s)
| | - Astia Allenzara
- Division of Rheumatology, Allergy and Immunology and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew Helm
- Department of Dermatology, Penn State College of Medicine, Hershey, PA, USA
| | - Galen T Foulke
- Department of Dermatology, Penn State College of Medicine, Hershey, PA, USA.
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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3
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Hasan G, Ferucci ED, Buyon JP, Belmont HM, Salmon JE, Askanase A, Bathon JM, Geraldino-Pardilla L, Ali Y, Ginzler EM, Putterman C, Gordon C, Helmick CG, Parton H, Izmirly PM. Population-based prevalence and incidence estimates of mixed connective tissue disease from the Manhattan Lupus Surveillance Program. Rheumatology (Oxford) 2023; 62:2845-2849. [PMID: 36538873 PMCID: PMC11068036 DOI: 10.1093/rheumatology/keac703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/07/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE Epidemiological data for MCTD are limited. Leveraging data from the Manhattan Lupus Surveillance Program (MLSP), a racially/ethnically diverse population-based registry of cases with SLE and related diseases including MCTD, we provide estimates of the prevalence and incidence of MCTD. METHODS MLSP cases were identified from rheumatologists, hospitals and population databases using a variety of International Classification of Diseases, Ninth Revision codes. MCTD was defined as one of the following: fulfilment of our modified Alarcon-Segovia and Kahn criteria, which required a positive RNP antibody and the presence of synovitis, myositis and RP; a diagnosis of MCTD and no other diagnosis of another CTD; and a diagnosis of MCTD regardless of another CTD diagnosis. RESULTS Overall, 258 (7.7%) cases met a definition of MCTD. Using our modified Alarcon-Segovia and Kahn criteria for MCTD, the age-adjusted prevalence was 1.28 (95% CI 0.72, 2.09) per 100 000. Using our definition of a diagnosis of MCTD and no other diagnosis of another CTD yielded an age-adjusted prevalence and incidence of MCTD of 2.98 (95% CI 2.10, 4.11) per 100 000 and 0.39 (95% CI 0.22, 0.64) per 100 000, respectively. The age-adjusted prevalence and incidence were highest using a diagnosis of MCTD regardless of other CTD diagnoses and were 16.22 (95% CI 14.00, 18.43) per 100 000 and 1.90 (95% CI 1.49, 2.39) per 100 000, respectively. CONCLUSIONS The MLSP provided estimates for the prevalence and incidence of MCTD in a diverse population. The variation in estimates using different case definitions is reflective of the challenge of defining MCTD in epidemiologic studies.
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Affiliation(s)
- Ghadeer Hasan
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Elizabeth D Ferucci
- Division of Community Health Services, Department of Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - H Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Jane E Salmon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Anca Askanase
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Joan M Bathon
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Laura Geraldino-Pardilla
- Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Yousaf Ali
- Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ellen M Ginzler
- Division of Rheumatology, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Chaim Putterman
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Charles G Helmick
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hilary Parton
- Division of Disease Control, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, USA
| | - Peter M Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
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4
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Salvi GE, Roccuzzo A, Imber JC, Stähli A, Klinge B, Lang NP. Clinical periodontal diagnosis. Periodontol 2000 2023. [PMID: 37452444 DOI: 10.1111/prd.12487] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/16/2023] [Accepted: 03/14/2023] [Indexed: 07/18/2023]
Abstract
Periodontal diseases include pathological conditions elicited by the presence of bacterial biofilms leading to a host response. In the diagnostic process, clinical signs such as bleeding on probing, development of periodontal pockets and gingival recessions, furcation involvement and presence of radiographic bone loss should be assessed prior to periodontal therapy, following active therapy, and during long-term supportive care. In addition, patient-reported outcomes such as increased tooth mobility, migration, and tilting should also be considered. More important to the patient, however, is the fact that assessment of signs of periodontal diseases must be followed by an appropriate treatment plan. Furthermore, it should be realized that clinical and radiographic periodontal diagnosis is based on signs which may not reflect the presence of active disease but rather represent the sequelae of a previous bacterial challenge. Hence, the aim of the present review is to provide a summary of clinical and radiographic diagnostic criteria required to classify patients with periodontal health or disease.
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Affiliation(s)
- Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Björn Klinge
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Niklaus P Lang
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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5
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Ceresnie MS, Gonzalez S, Hamzavi IH. Diagnosing Disorders of Hypopigmentation and Depigmentation in Patients with Skin of Color. Dermatol Clin 2023; 41:407-416. [PMID: 37236710 DOI: 10.1016/j.det.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Skin hypopigmentation and depigmentation disorders are a top concern for patients with skin of color seeking care from a dermatologist. The visual contrast between involved and uninvolved skin in these disorders makes them particularly burdensome for patients with skin of color. These disorders may have a wide differential of diagnosis, as patients with skin of color may present differently or more frequently than White patients for certain conditions. Clues from a comprehensive history and physical examination with standard lighting and a Wood's light are essential for clinching the diagnosis, although a biopsy may be warranted in special cases.
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Affiliation(s)
- Marissa S Ceresnie
- Department of Dermatology, Multicultural Clinic, Henry Ford Health, 3031 West Grand Boulevard, Suite 700, Detroit, MI 48202, USA
| | - Sarah Gonzalez
- Wayne State University College of Medicine, 540 East Canfield Avenue, Detroit, MI 48201, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Multicultural Clinic, Henry Ford Health, 3031 West Grand Boulevard, Suite 700, Detroit, MI 48202, USA.
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6
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Guttmann A, Denvir B, Aringer M, Buyon JP, Belmont HM, Sahl S, Salmon JE, Askanase A, Bathon JM, Geraldino-Pardilla L, Ali Y, Ginzler EM, Putterman C, Gordon C, Helmick CG, Parton H, Izmirly PM. Evaluation of the EULAR/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus in a Population-Based Registry. Arthritis Care Res (Hoboken) 2023; 75:1007-1016. [PMID: 35638708 PMCID: PMC11098446 DOI: 10.1002/acr.24960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/04/2022] [Accepted: 05/24/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Using the Manhattan Lupus Surveillance Program, a multiracial/ethnic population-based registry, we aimed to compare 3 commonly used classification criteria for systemic lupus erythematosus (SLE) to identify unique cases and determine the incidence and prevalence of SLE using the EULAR/American College of Rheumatology (ACR) criteria. METHODS SLE cases were defined as fulfilling the 1997 ACR, the Systemic Lupus International Collaborating Clinics (SLICC), or the EULAR/ACR classification criteria. We quantified the number of cases uniquely associated with each and the number fulfilling all 3 criteria. Prevalence and incidence using the EULAR/ACR classification criteria and associated 95% confidence intervals (95% CIs) were calculated. RESULTS A total of 1,497 cases fulfilled at least 1 of the 3 classification criteria, with 1,008 (67.3%) meeting all 3 classifications, 138 (9.2%) fulfilling only the SLICC criteria, 35 (2.3%) fulfilling only the 1997 ACR criteria, and 34 (2.3%) uniquely fulfilling the EULAR/ACR criteria. Patients solely satisfying the EULAR/ACR criteria had <4 manifestations. The majority classified only by the 1997 ACR criteria did not meet any of the defined immunologic criteria. Patients fulfilling only the SLICC criteria did so based on the presence of features unique to this system. Using the EULAR/ACR classification criteria, age-adjusted overall prevalence and incidence rates of SLE in Manhattan were 59.6 (95% CI 55.9-63.4) and 4.9 (95% CI 4.3-5.5) per 100,000 population, with age-adjusted prevalence and incidence rates highest among non-Hispanic Black female patients. CONCLUSION Applying the 3 commonly used classification criteria to a population-based registry identified patients with SLE fulfilling only 1 validated definition. The most recently developed EULAR/ACR classification criteria revealed prevalence and incidence estimates similar to those previously established for the ACR and SLICC classification schemes.
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Affiliation(s)
- Allison Guttmann
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Brendan Denvir
- Department of Medicine, New York University School of Medicine
| | - Martin Aringer
- University Medical Center and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jill P. Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - H. Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Sara Sahl
- Department of Pediatrics, Harbor-University of California Medical Center Los Angeles, CA
| | - Jane E. Salmon
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY
| | - Anca Askanase
- Division of Rheumatology, Department of Medicine Columbia University College of Physicians & Surgeons, New York, NY
| | - Joan M. Bathon
- Division of Rheumatology, Department of Medicine Columbia University College of Physicians & Surgeons, New York, NY
| | - Laura Geraldino-Pardilla
- Division of Rheumatology, Department of Medicine Columbia University College of Physicians & Surgeons, New York, NY
| | - Yousaf Ali
- Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ellen M. Ginzler
- Division of Rheumatology, Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn
| | - Chaim Putterman
- Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Charles G. Helmick
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hilary Parton
- New York City Department of Health and Mental Hygiene, Long Island City, New York
| | - Peter M. Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
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7
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Chen HW, Coias JL, Raman J, Adams-Huet B, Neeland IJ, Chong BF. Older black race is a risk factor for metabolic syndrome in cutaneous lupus erythematosus. Lupus 2023; 32:580-582. [PMID: 36744807 PMCID: PMC10121811 DOI: 10.1177/09612033231154785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Henry W Chen
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Justin Raman
- 12233University of Florida College of Medicine, Gainesville, FL, USA
| | - Beverley Adams-Huet
- Department of Population and Data Sciences, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ian J Neeland
- Harrington Heart and Vascular Institute, Division of Cardiovascular Medicine, University Hospitals Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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8
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Stull C, Sprow G, Werth VP. Cutaneous Involvement in Systemic Lupus Erythematosus: A Review for the Rheumatologist. J Rheumatol 2023; 50:27-35. [PMID: 36109075 PMCID: PMC10152495 DOI: 10.3899/jrheum.220089] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 02/08/2023]
Abstract
The majority of patients with systemic lupus erythematosus (SLE) have cutaneous manifestations at some point in their disease course. The skin findings in SLE are classified as SLE-specific or SLE-nonspecific based on histopathologic findings. SLE-specific skin diseases include chronic cutaneous lupus erythematosus (CLE), subacute CLE, and acute CLE. There are subsets of skin lesions within each group and the likelihood of associated SLE varies among them. SLE-nonspecific lesions are more common in patients with SLE and tend to coincide with active systemic disease. SLE-nonspecific lesions may be seen as a feature of another disease process, including other connective tissue diseases. It is important for the rheumatologist to be familiar with the spectrum of cutaneous diseases in SLE to help prognosticate the likelihood of systemic disease and to ensure patients receive timely dermatologic care with the goal of controlling disease activity to prevent damage.
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Affiliation(s)
- Courtney Stull
- C. Stull, MD, Corporal Michael J. Crescenz VAMC, and Department of Dermatology, University of Pennsylvania, Philadelphia, and Department of Rheumatology, University of Pittsburgh Medical Center, Pittsburgh
| | - Grant Sprow
- G. Sprow, BA, V.P. Werth, MD, Corporal Michael J. Crescenz VAMC, and Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria P Werth
- G. Sprow, BA, V.P. Werth, MD, Corporal Michael J. Crescenz VAMC, and Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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9
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Keum H, Brown LS, Chong BF. Black patients with cutaneous lupus are associated with positive family history of cutaneous lupus and systemic lupus. Lupus Sci Med 2022; 9:9/1/e000688. [PMID: 36600582 PMCID: PMC9730360 DOI: 10.1136/lupus-2022-000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/27/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Various genetic polymorphisms have been associated with an increased risk of cutaneous lupus erythematosus (CLE). However, it is not fully known how often positive family histories occur in patients with CLE. The aims of this study are to determine the rate of positive family history among patients with CLE and to identify risk factors associated with positive family history. METHODS A retrospective cohort study was conducted among 338 patients with CLE seen in outpatient dermatology clinics in a tertiary referral centre in Dallas, Texas. The primary outcome was positive family history of CLE and/or SLE, as defined by the presence of self-reported CLE and/or SLE in first-degree or more distant relatives of a patient. Univariate analyses were performed to identify risk factors associated with positive family history of CLE and/or SLE in patients with CLE. Multivariable logistic regression analyses were performed to determine significant predictors of positive family history of CLE and/or SLE. RESULTS 34% (n=114) of patients reported positive family history of CLE and/or SLE. 7% (n=23) of patients with CLE had relatives with CLE, with 5% (n=18) having a first-degree relative with CLE. 30% (n=102) of patients with CLE had relatives with SLE, and 15% (n=52) had a first-degree relative with SLE. Black patients were more likely to have positive family history of CLE and/or SLE (OR 2.13, 95% CI 1.23 to 3.69, p=0.007). CONCLUSIONS More patients with CLE had positive family history of SLE than CLE. Black patients with CLE were more likely to have a relative with CLE and/or SLE. Providers can use this information to counsel patients with CLE on the risk of other family members having CLE and/or SLE. These data may help identify potentially new genetic polymorphisms associated with positive family history.
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Affiliation(s)
- Heejo Keum
- Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - L Steven Brown
- Health Systems Research, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Benjamin F Chong
- Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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10
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Anderson SR, Hynan LS, Chong BF. Late-onset cutaneous lupus erythematosus patients have distinctive clinical features and demographics versus early-onset patients. Lupus 2022; 31:1523-1528. [PMID: 35995793 DOI: 10.1177/09612033221122254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cutaneous lupus erythematosus (CLE) can present later in life, but frequency and risk factors of late-onset CLE patients are not well characterized. The study determined frequency of late-onset CLE and compared the demographic and disease characteristics between early-onset and late-onset CLE in a cohort of patients with CLE. OBJECTIVES To determine the frequency and compare clinical features of early-onset and late-onset CLE. METHODS This was a cross-sectional study of CLE patients seen in outpatient dermatology clinics at University of Texas Southwestern Medical Center (UTSW) and Parkland Health and Hospital System, Dallas, TX, from April 2009 to May 2019. The primary outcome was the age of CLE onset, stratified by early-onset (<50 years) and late-onset CLE (≥50 years). Predictor variables significantly associated with CLE onset groups were identified by univariate and multivariable logistic regression analyses. RESULTS Of the 291 CLE patients studied, 79% were early-onset, and 21% were late-onset. Multivariable logistic regression analyses identified that Caucasian race (odds ratio (OR): 2.23, 95% Confidence Interval (CI): 1.19-4.19, p = 0.013), having a CLE subtype other than chronic (OR: 2.18, 95% CI: 1.02-4.65, p = 0.044), and drug-induced cases (OR: 4.65, 95% CI: 1.18-18.24, p = 0.028) were significantly associated with late-onset CLE. Early-onset CLE patients were more likely to have oral ulcers (OR: 3.58, 95% CI: 1.46-8.78, p = 0.005) and renal disorders (OR: 4.02, 95% CI: 1.10-14.71, p = 0.036). LIMITATIONS This was a single center study. Age of onset was self-reported and late-onset CLE cohort has a small sample size. CONCLUSIONS Our diverse cohort of CLE patients had about one out of five patients with CLE experiencing disease onset after 50 years old. These patients have distinct demographic and clinical presentations compared to early-onset CLE patients. Providers should remain mindful of CLE in older patients with photosensitive rashes and mild systemic symptoms.
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Affiliation(s)
- Scott R Anderson
- John T. Milliken Department of Medicine, 12275Washington University School of Medicine, St Louis, MO, USA
| | - Linda S Hynan
- Departments of Population and Data Sciences & Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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11
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Drenkard C, Barbour KE, Greenlund KJ, Lim SS. The Burden of Living With Cutaneous Lupus Erythematosus. Front Med (Lausanne) 2022; 9:897987. [PMID: 36017007 PMCID: PMC9395260 DOI: 10.3389/fmed.2022.897987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Cutaneous lupus erythematosus (CLE) is a group of heterogeneous autoimmune disorders primarily affecting the skin. Patients with these conditions are mostly young women when they become sick and often suffer from recurrent skin symptoms or longstanding changes in their physical appearance. CLE disorders lead to different levels of morbidity and can impact profoundly patients' quality of life, particularly in the psychological and social health domains. This review provides a summary of recent research investigating the psychosocial burden of living with CLE and the intersect amongst the disease characteristics, patient factors, and social determinants of health. Furthermore, this review provides insight into patient care and research needs that remain unmet to improve the quality of life of patients living with CLE.
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Affiliation(s)
- Cristina Drenkard
- Division of Rheumatology, Department of Medicine, Emory School of Medicine, Atlanta, GA, United States
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- *Correspondence: Cristina Drenkard
| | - Kamil E. Barbour
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kurt J. Greenlund
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - S. Sam Lim
- Division of Rheumatology, Department of Medicine, Emory School of Medicine, Atlanta, GA, United States
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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12
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Walker AM, Lu G, Clifton SC, Ogunsanya ME, Chong BF. Influence of Socio-Demographic Factors in Patients With Cutaneous Lupus Erythematosus. Front Med (Lausanne) 2022; 9:916134. [PMID: 35899206 PMCID: PMC9311297 DOI: 10.3389/fmed.2022.916134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Cutaneous lupus erythematosus (CLE) is a chronic autoimmune skin disease with potential for systemic involvement, disfigurement, and significant disease burden. The relationships of demographics and socioeconomic status with patients with CLE are emerging topics with important clinical implications. The primary objective of our study is to perform a literature review of studies that have investigated demographic and socioeconomic factors amongst patients with CLE and determine whether these factors influence diagnosis frequency, disease severity and outcomes or health related quality of life. We searched multiple databases to identify literature addressing CLE and concepts such as race, ethnicity, gender, income, education level and geographic location. Information regarding primary research objective was extracted from all full text articles, and a summary of findings was prepared. We found that race and ethnicity can influence CLE diagnosis frequency and disease outcomes. Chronic cutaneous lupus (CCLE) occurs more frequently in Black patients, often with higher overall disease damage. Differences between genders exist in CLE in terms of health-related quality of life, as female gender was a risk factor for worse quality of life in several studies. Lower income, low educational attainment, and lack of health insurance all contribute to poorer overall outcomes in CLE patients. This review will help inform physicians about populations at risk for potentially worse outcomes to guide treatment decisions for patients with CLE and provide important information to design interventions that address modifiable social determinants of health in this population.
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Affiliation(s)
- Amanda M. Walker
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Grace Lu
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Shari C. Clifton
- Health Sciences Library and Information Management, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Motolani E. Ogunsanya
- Department of Pharmacy, Clinical and Administrative Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Benjamin F. Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, United States
- *Correspondence: Benjamin F. Chong
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13
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Ezeh N, Ardalan K, Buhr KA, Nguyen C, Al Ahmed O, Ardoin SP, Barton V, Bell S, Brandling-Bennett H, Castelo-Soccio L, Chiu YE, Chong BF, Lara-Corrales I, Cintosun A, Curran ML, Diaz LZ, Elman SA, Faith EF, Garcia-Romero MT, Grossman-Kranseler J, Hogeling M, Hudson AD, Hunt RD, Ibler EM, Marques MC, Monir RL, Oza V, Paller AS, Putterman E, Rodriguez-Salgado P, Schoch JJ, Truong A, Wang J, Lee LW, Vleugels RA, Klein-Gitelman MS, von Scheven E, Werth VP, Arkin LM. Cross-Sectional Characteristics of Pediatric-Onset Discoid Lupus Erythematosus: Results of a Multicenter, Retrospective Cohort Study. J Am Acad Dermatol 2022; 87:559-566. [PMID: 35487332 PMCID: PMC10082546 DOI: 10.1016/j.jaad.2022.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/15/2022]
Abstract
• Discoid lupus may be associated with SLE. In this study, most children with discoid lupus did not have systemic disease. Concurrent SLE was highest in female adolescents (>10 years of age) with generalized discoid lupus, who had clinically aggressive disease. • Discoid lupus in adolescence should prompt thorough evaluation for SLE.
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Affiliation(s)
- N Ezeh
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - K Ardalan
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, Departments of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - K A Buhr
- Department of Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - C Nguyen
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - O Al Ahmed
- Department of Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus OH
| | - S P Ardoin
- Department of Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus OH
| | - V Barton
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, SC
| | - S Bell
- Department of Pediatrics, Division of Rheumatology, University of California at San Francisco, San Francisco, CA
| | - H Brandling-Bennett
- Division of Dermatology; Department of Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, WA
| | - L Castelo-Soccio
- Children's Hospital of Philadelphia, Department of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Y E Chiu
- Departments of Dermatology (Section of Pediatric Dermatology) and Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - B F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Pediatrics, Division of Allergy/Immunology/Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - I Lara-Corrales
- Department of Pediatrics, Section of Dermatology, The Hospital for Sick Children/University of Toronto, Toronto, ON
| | - A Cintosun
- Department of Pediatrics, Section of Dermatology, The Hospital for Sick Children/University of Toronto, Toronto, ON
| | - M L Curran
- Department of Pediatrics, Section of Rheumatology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO
| | - L Z Diaz
- Department of Pediatrics, Division of Dermatology, Dell Medical School/Dell Children's Hospital, Austin, TX
| | - S A Elman
- Department of Dermatology, Boston's Children Hospital/Harvard Medical School, Boston, MA
| | - E Fernandez Faith
- Department of Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus OH
| | - M T Garcia-Romero
- Department of Dermatology, National Institute for Pediatrics, Mexico City, MX
| | - J Grossman-Kranseler
- Division of Dermatology; Department of Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, WA
| | - M Hogeling
- Department of Dermatology, University of California at Los Angeles, Los Angeles, CA
| | - A D Hudson
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
| | - R D Hunt
- Department of Dermatology and Pediatrics, Texas Children's Hospital, Houston, TX
| | - E M Ibler
- Departments of Dermatology (Section of Pediatric Dermatology) and Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - M C Marques
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - R L Monir
- Department of Dermatology, University of Florida School of Medicine, Gainesville, FL
| | - V Oza
- Departments of Pediatrics and Dermatology, New York University Grossman School of Medicine, New York, NY
| | - A S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - E Putterman
- Children's Hospital of Philadelphia, Department of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - P Rodriguez-Salgado
- Department of Dermatology, National Institute for Pediatrics, Mexico City, MX
| | - J J Schoch
- Department of Dermatology, University of Florida School of Medicine, Gainesville, FL
| | - A Truong
- Department of Dermatology, University of California at Los Angeles, Los Angeles, CA
| | - J Wang
- Departments of Pediatrics and Dermatology, New York University Grossman School of Medicine, New York, NY
| | - L Wine Lee
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, SC
| | - R A Vleugels
- Department of Dermatology, Boston's Children Hospital/Harvard Medical School, Boston, MA
| | - M S Klein-Gitelman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - E von Scheven
- Department of Pediatrics, Division of Rheumatology, University of California at San Francisco, San Francisco, CA
| | - V P Werth
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - L M Arkin
- Departments of Dermatology and Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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14
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Okoji UK, Agim NG, Heath CR. Features of Common Skin Disorders in Pediatric Patients with Skin of Color. Dermatol Clin 2022; 40:83-93. [PMID: 34799038 DOI: 10.1016/j.det.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Many dermatologic conditions common in the pediatric population may have unique presentations in skin of color or occur with greater incidence. This may be due to ethnic origin, socioeconomic factors, or other influences. Awareness of the potential variations in skin of color may enhance prompt diagnosis, appropriate treatment, and/or reassurance as indicated.
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Affiliation(s)
- Uchenna K Okoji
- Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, USA
| | - Nnenna G Agim
- University of Texas Southwestern, 2350 North Stemmons Freeway, Dallas, TX 75220, USA
| | - Candrice R Heath
- Lewis Katz School of Medicine, Temple University, 3401 North Broad Street, 5-OPB Dermatology, Philadelphia, PA 19140, USA.
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15
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Izmirly PM, Ferucci ED, Somers EC, Wang L, Lim SS, Drenkard C, Dall'Era M, McCune WJ, Gordon C, Helmick C, Parton H. Incidence rates of systemic lupus erythematosus in the USA: estimates from a meta-analysis of the Centers for Disease Control and Prevention national lupus registries. Lupus Sci Med 2021; 8:8/1/e000614. [PMID: 34921094 PMCID: PMC8685969 DOI: 10.1136/lupus-2021-000614] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/25/2021] [Indexed: 11/12/2022]
Abstract
Objective To estimate the annual incidence rate of SLE in the USA. Methods A meta-analysis used sex/race/ethnicity-specific data spanning 2002–2009 from the Centers for Disease Control and Prevention network of four population-based state registries to estimate the incidence rates. SLE was defined as fulfilling the 1997 revised American College of Rheumatology classification criteria. Given heterogeneity across sites, a random effects model was employed. Applying sex/race/ethnicity-stratified rates, including data from the Indian Health Service registry, to the 2018 US Census population generated estimates of newly diagnosed SLE cases. Results The pooled incidence rate per 100 000 person-years was 5.1 (95% CI 4.6 to 5.6), higher in females than in males (8.7 vs 1.2), and highest among black females (15.9), followed by Asian/Pacific Islander (7.6), Hispanic (6.8) and white (5.7) females. Male incidence was highest in black males (2.4), followed by Hispanic (0.9), white (0.8) and Asian/Pacific Islander (0.4) males. The American Indian/Alaska Native population had the second highest race-specific SLE estimates for females (10.4 per 100 000) and highest for males (3.8 per 100 000). In 2018, an estimated 14 263 persons (95% CI 11 563 to 17 735) were newly diagnosed with SLE in the USA. Conclusions A network of population-based SLE registries provided estimates of SLE incidence rates and numbers diagnosed in the USA.
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Affiliation(s)
- Peter M Izmirly
- Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine, New York, New York, USA
| | - Elizabeth D Ferucci
- Department of Research Services, Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, Alaska, USA
| | - Emily C Somers
- University of Michigan Schools of Medicine & Public Health, Ann Arbor, Michigan, USA
| | - Lu Wang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University, Atlanta, GA, USA
| | - Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University, Atlanta, GA, USA
| | - Maria Dall'Era
- University of California, San Francisco, California, USA
| | - W Joseph McCune
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Charles Helmick
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hilary Parton
- New York City Department of Health and Mental Hygiene, New York, New York, USA
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16
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Joseph AK, Windsor B, Hynan LS, Chong BF. Discoid lupus erythematosus skin lesion distribution and characteristics in Black patients: a retrospective cohort study. Lupus Sci Med 2021; 8:8/1/e000514. [PMID: 34853149 PMCID: PMC8638450 DOI: 10.1136/lupus-2021-000514] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/29/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Epidemiological studies have shown that discoid lupus erythematosus (DLE) has a higher incidence and prevalence in racial/ethnic minority groups, particularly Black individuals. The objective of this retrospective cohort study was to identify the differences in DLE lesion distribution and characteristics in Black individuals compared with non-Black individuals. METHODS 183 patients with DLE (112 Black patients and 71 non-Black patients) with a reported race/ethnicity and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) scores were included in this retrospective cohort study. Univariate analysis was performed to determine significant differences in demographic data, clinical characteristics, DLE lesion distribution and DLE lesion characteristics in Black and non-Black patients with DLE. Multivariable logistic regression was preformed to determine significant predictors of DLE lesion location and characteristics. RESULTS Black patients with DLE had worse baseline CLASI damage scores compared with non-Black patients with DLE (median (IQR): 10.0 (6.0-14.5) vs 6.0 (3.0-10.0), p<0.001) and had 48.9 greater odds of dyspigmentation in any anatomical location (p<0.001). Black patients had 2.54 greater odds of having scalp involvement (p=0.015) and 1.97 greater odds of having ear involvement (p=0.032) compared with non-Black patients. Black patients also had greater odds of scalp dyspigmentation (OR=5.85, p<0.001), ear dyspigmentation (OR=2.89, p=0.001) and scarring alopecia (OR=3.00, p=0.001) compared with non-Black patients. CONCLUSIONS Signs of disease damage, particularly ear dyspigmentation, scalp dyspigmentation and scarring alopecia, can more frequently affect Black patients with DLE. Recognising differences in clinical presentation of DLE among Black patients can assist future efforts with understanding biological, cultural, psychosocial and systemic factors that influence DLE presentation and outcomes in Black patients and may guide clinicians when counselling Black patients.
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Affiliation(s)
- Adrienne K Joseph
- Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brandon Windsor
- Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Linda S Hynan
- Population and Data Sciences, Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin F Chong
- Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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17
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Redmond C, Pamuk O, Hasni SA. Lupus Cohorts. Rheum Dis Clin North Am 2021; 47:457-479. [PMID: 34215374 DOI: 10.1016/j.rdc.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Large cohorts with diverse ethnic backgrounds and heterogenous clinical features have provided the real-life data about the safety and efficacy of various treatment regimens for systemic lupus erythematosus (SLE). There are multiple well-established regional, national, and international lupus cohorts that have made significant contributions to the understanding of SLE. Using social media for cohort-based studies can significantly increase the outreach in a short time period for studying rare diseases such as SLE. Lack of strict inclusion criteria allows study of a broad range of patients but selection bias and incomplete data are possible in long-term cohort studies.
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Affiliation(s)
- Christopher Redmond
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Omer Pamuk
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sarfaraz A Hasni
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
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18
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Izmirly PM, Parton H, Wang L, McCune WJ, Lim SS, Drenkard C, Ferucci ED, Dall'Era M, Gordon C, Helmick CG, Somers EC. Prevalence of Systemic Lupus Erythematosus in the United States: Estimates From a Meta-Analysis of the Centers for Disease Control and Prevention National Lupus Registries. Arthritis Rheumatol 2021; 73:991-996. [PMID: 33474834 PMCID: PMC8169527 DOI: 10.1002/art.41632] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/23/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Epidemiologic data on systemic lupus erythematosus (SLE) are limited, particularly for racial/ethnic subpopulations in the US. This meta-analysis leveraged data from the Centers for Disease Control and Prevention (CDC) National Lupus Registry network of population-based SLE registries to estimate the overall prevalence of SLE in the US. METHODS The CDC National Lupus Registry network includes 4 registries from unique states and a fifth registry from the Indian Health Service. All registries defined cases of SLE according to the American College of Rheumatology (ACR) 1997 revised classification criteria for SLE. Case findings spanned either 2002-2004 or 2007-2009. Given the heterogeneity across sites, a random-effects model was used to calculate the pooled prevalence of SLE. An estimate of the number of SLE cases in the US was generated by applying sex/race-stratified estimates to the 2018 US Census population. RESULTS In total, 5,417 cases were identified as fulfilling the ACR SLE classification criteria. The pooled prevalence of SLE from the 4 state-specific registries was 72.8 per 100,000 person-years (95% confidence interval [95% CI] 65.3-81.0). The prevalence estimate was 9 times higher among females than among males (128.7 versus 14.6 per 100,000), and highest among Black females (230.9 per 100,000), followed by Hispanic females (120.7 per 100,000), White females (84.7 per 100,000), and Asian/Pacific Islander females (84.4 per 100,000). Among males, the prevalence of SLE was highest in Black males (26.7 per 100,000), followed by Hispanic males (18.0 per 100,000), Asian/Pacific Islander males (11.2 per 100,000), and White males (8.9 per 100,000). The American Indian/Alaska Native population had the highest race-specific SLE estimates, both among females (270.6 per 100,000) and among males (53.8 per 100,000). In 2018, an estimated 204,295 individuals (95% CI 160,902-261,725) in the US fulfilled the ACR classification criteria for SLE. CONCLUSION A coordinated network of population-based SLE registries provides more accurate estimates of the prevalence of SLE and the numbers of individuals affected with SLE in the US in 2018.
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Affiliation(s)
- Peter M. Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY
| | - Hilary Parton
- New York City Department of Health and Mental Hygiene, Long Island City, New York, NY
| | - Lu Wang
- Department of Biostatistics, University of Michigan Schools of Medicine & Public Health, Ann Arbor, MI
| | - W. Joseph McCune
- Division of Rheumatology, Department of Medicine, University of Michigan Schools of Medicine, Ann Arbor, MI
| | - S. Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University, Atlanta, GA
| | - Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University, Atlanta, GA
| | - Elizabeth D. Ferucci
- Division of Community Health Services, Department of Clinical and Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Maria Dall'Era
- Department of Medicine, University of California at San Francisco, San Francisco, CA
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Charles G. Helmick
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Emily C. Somers
- Division of Rheumatology, Department of Internal Medicine, Department of Environmental Health Sciences, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor MI
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19
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Zhu JL, Tran LT, Smith M, Zheng F, Cai L, James JA, Guthridge JM, Chong BF. Modular gene analysis reveals distinct molecular signatures for subsets of patients with cutaneous lupus erythematosus. Br J Dermatol 2021; 185:563-572. [PMID: 33400293 DOI: 10.1111/bjd.19800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune disease with clinical sequelae such as itching, dyspigmentation and scarring. OBJECTIVES We applied a previously described modular analysis approach to assess the molecular heterogeneity of patients with CLE. METHODS Whole-blood transcriptomes of RNA sequencing data from a racially and ethnically diverse group of patients with CLE (n = 62) were used to calculate gene co-expression module scores. An unsupervised cluster analysis and k-means clustering based on these module scores were then performed. We used Fisher's exact tests and Kruskal-Wallis tests to compare characteristics between patient clusters. RESULTS Six unique clusters of patients with CLE were identified from the cluster analysis. We observed that seven inflammation modules were elevated in two clusters of patients with CLE. Additionally, these clusters were characterized by interferon, neutrophil and cell-death signatures, suggesting that interferon-related proteins, neutrophils and cell-death processes could be driving the inflammatory response in these subgroups. Three different clusters had a predominant T-cell signature, which were supported by lymphocyte counts. CONCLUSIONS Our data support a diverse molecular profile in CLE that further adds to the clinical variations of this skin disease, and may affect disease course and treatment selection. Future studies with a larger and diverse cohort of patients with CLE are warranted to confirm these findings.
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Affiliation(s)
- J L Zhu
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - L T Tran
- Arthritis and Clinical Research Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - M Smith
- Arthritis and Clinical Research Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - F Zheng
- Arthritis and Clinical Research Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - L Cai
- Department of Population and Data Sciences, Quantitative Biomedical Research Center, Dallas, TX, USA
| | - J A James
- Arthritis and Clinical Research Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - J M Guthridge
- Arthritis and Clinical Research Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - B F Chong
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
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