Ezeh N, Ardalan K, Buhr K A, Nguyen C, Al Ahmed O, Ardoin S P, Barton V, Bell S, Brandling-Bennett H, Castelo-Soccio L, Chiu Y E, Chong B F, Co D O, Lara-Corrales I, Cintosun A, Curran M L, Diaz L Z, Elman S A, Faith E Fernandez, Garcia-Romero M T, Grossman-Kranseler J, Hogeling M, Hudson A D, Hunt R D, Ibler E M, Marques M C, Monir R L, Oza V, Paller A S, Putterman E, Rodriguez-Salgado P, Schoch J J, Truong A, Wang J, Lee L Wine, Vleugels R A, Klein-Gitelman M S, von Scheven E, Werth V P, Arkin Lisa M
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina; Departments of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
J Am Acad Dermatol. 2022 Sep;87(3):559-566. doi: 10.1016/j.jaad.2022.04.028. Epub 2022 Apr 26.
The incidence of systemic lupus in children with discoid lupus is unknown.
This study assessed the baseline characteristics of patients with pediatric discoid lupus erythematosus (pDLE).
Medical records at 17 sites were reviewed for pediatric dermatology and rheumatology patients with discoid lupus erythematosus. The inclusion criteria were clinical and/or histopathologic diagnosis of discoid lupus erythematosus with an age at onset of <18 years. Baseline data were collected at the first documented visit. Outcomes included diagnosis of systemic lupus erythematosus (SLE) at the baseline visit using the 1997 American College of Rheumatology (primary) and the 2012 Systemic Lupus International Collaborating Clinics (secondary) criteria.
Of the >1500 charts reviewed, 438 patients met the inclusion criteria. The cohort was predominantly female (72%) and racially/ethnically diverse. A diagnosis of SLE at the baseline visit (pDLE + SLE) was rendered in 162 (37%) patients using the American College of Rheumatology and in 181 (41%) patients using the Systemic Lupus International Collaborating Clinics criteria. Patients with pDLE + SLE were older at the time of rash onset (median, 12.9 vs 8.9 years; P < .001), with shorter time from discoid lupus erythematosus onset to diagnosis, compared with patients with pDLE-only (median, 2 vs 7 months; P < .001). Patients with pDLE + SLE were more likely to be female (P = .004), with generalized discoid lupus erythematosus and clinically aggressive disease, including end-organ involvement, positive serologies, and higher- titer levels of antinuclear antibodies (P < .001).
Retrospective study.
A diagnosis of discoid lupus erythematosus in adolescence should prompt thorough screening for SLE.
盘状狼疮患儿中系统性红斑狼疮的发病率尚不清楚。
本研究评估了儿童盘状红斑狼疮（pDLE）患者的基线特征。
回顾了17个地点的儿科皮肤科和风湿病科患有盘状红斑狼疮患者的病历。纳入标准为临床和/或组织病理学诊断为盘状红斑狼疮且发病年龄<18岁。在首次有记录的就诊时收集基线数据。结局包括使用1997年美国风湿病学会（主要）和2012年系统性红斑狼疮国际协作临床中心（次要）标准在基线就诊时诊断系统性红斑狼疮（SLE）。
在审查的1500多份病历中，438例患者符合纳入标准。该队列主要为女性（72%），种族/民族多样。使用美国风湿病学会标准，162例（37%）患者在基线就诊时被诊断为SLE（pDLE + SLE）；使用系统性红斑狼疮国际协作临床中心标准，181例（41%）患者被诊断为SLE。与仅患有pDLE的患者相比，pDLE + SLE患者皮疹发作时年龄更大（中位数分别为12.9岁和8.9岁；P <.001），从盘状红斑狼疮发作到诊断的时间更短（中位数分别为2个月和7个月；P <.001）。pDLE + SLE患者更可能为女性（P =.004），患有泛发性盘状红斑狼疮且临床疾病侵袭性更强，包括终末器官受累、血清学阳性以及抗核抗体滴度更高（P <.001）。
回顾性研究。
青少年期诊断为盘状红斑狼疮应促使对SLE进行全面筛查。
