Detection of Ro/SS-A antibodies in lupus erythematosus: what does it mean for the dermatologist?

BACKGROUND

Lupus erythematosus (LE) is a systemic autoimmune disease. However, some patients have only cutaneous LE (CLE), whereas others develop internal organ involvement. Ro/SS-A antibodies are frequently detected in photosensitive variants of LE.

OBJECTIVE

The prevalence of LE-specific and LE-nonspecific cutaneous manifestations and their relation to internal organ involvement in Ro/SS-A antibody-positive patients were investigated.

METHODS

All Ro/SS-A-positive patients between January 2000 and December 2011 were reviewed. Only patients with Ro/SS-A antibodies and LE were enrolled and retrospectively analyzed.

RESULTS

In all, 215 Ro/SS-A antibody-positive patients were given the diagnosis of LE. Older patients (>50 years old) presenting with subacute CLE or chronic CLE and negative antinuclear antibody usually only experienced skin involvement. In contrast, internal organ involvement was observed in younger patients (<50 years old) with subacute CLE or chronic CLE presenting with the clinical and laboratory markers: fatigue, positive antinuclear antibody, and additional extractable nuclear antigen. Young female patients with acute CLE should be recognized as a separate subset of Ro/SS-A antibody-positive patients because almost a third was given the diagnosis of kidney involvement. Logistic regression analysis revealed that internal organ involvement was observed in patients with LE presenting with LE-nonspecific cutaneous manifestations, arthralgia, leukopenia, positive antinuclear antibody, and fatigue.

LIMITATIONS

This was a retrospective study from a single referral center specializing in dermatologic diseases.

CONCLUSION

The particular cutaneous variant of LE and age at Ro/SS-A detection predict different risks for internal organ involvement in Ro/SS-A antibody-positive patients with LE.