CT-04 Using the american college of rheumatology and systemic lupus international collaborating clinics criteria to measure disease severity in discoid lupus erythematosus

Abstract

Background Discoid lupus erythematosus (DLE) progresses to systemic lupus erythematosus (SLE) in up to 28% of cases. The 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria were developed to improve the American College of Rheumatology (ACR) criteria. So far, the SLICC criteria have not been evaluated in DLE. Methods This is a case-control study comparing patients with DLE who meet ACR and/or SLICC criteria for SLE against patients with DLE-only disease. The data was obtained from an ongoing database with 142 DLE patients at Penn and from their respective medical records. Results Using the ACR criteria, 75 (53%) patients were classified as DLE/SLE and 67 (47%) as DLE-only, compared with 66 (47%) DLE/SLE and 76 (53%) DLE-only patients using the SLICC criteria (p = 0.08). This net increase of eight patients meeting ACR criteria was due to the presence of the photosensitivity criterion and fewer immunologic criteria under ACR. Due to the immunologic criteria requirement under SLICC, it can be challenging to determine an SLE diagnosis retrospectively. Overall, DLE/SLE patients were more likely than DLE-only patients to exhibit hematologic and immunologic criteria with respect to leukopenia (ACR p Conclusion These findings suggest that DLE patients who meet SLE criteria are more likely than their DLE-only counterparts to have more significant internal disease. Both ACR and SLICC criteria are useful in distinguishing DLE patients with internal organ involvement from those without. DLE-only patients may have significant skin disease with 25% of DLE-only patients having moderate to severe skin disease.