MARKERS IN CUTANEOUS LUPUS-ERYTHEMATOSUS INDICATING SYSTEMIC INVOLVEMENT - A MULTICENTER STUDY ON 296 PATIENTS

Lupus erythematosus (LE) is an autoimmune disorder, involving the skin and/or other internal organs. As cutaneous variants, chronic discoid LE (CDLE) and subacute cutaneous LE (SCLE) usually have a better progn osis, however, involvement of internal organs with transition into sys temic disease may occur. The aim of this study was to assess the signi ficance of some clinical and laboratory criteria that could serve as m arkers for early recognition of systemic involvement in cutaneous LE. Three hundred and seventy-nine patients with LE, seen in five cooperat ing Departments of Dermatology during the years 1989-1994, were docume nted by electronic data processing according to a common protocol. Two hundred and forty-five of these patients had cutaneous LE (CDLE or SC LE), and 51 had systemic LE (SLE) and were included in this study. For ty-nine patients with either CDLE/SCLE or SLE were not evaluated becau se of incomplete documentation; also, 34 patients suffered from other LE subsets and were likewise excluded from the evaluation. Multivariat e statistical analysis was used to assess the value of seven selected variables for distinguishing between the CDLE/SCLE and SLE groups: ESR , titers of antinuclear antibodies, anti-dsDNA-antibodies, photosensit ivity, presence of arthralgias, recurrent headaches and signs of nephr opathy. Univariate and multivariate analysis of the obtained data show ed that signs of nephropathy (proteinuria, hematuria) was the variable with the highest statistical relevance for distinguishing between pat ients with cutaneous (CDLE/SCLE) and with systemic LE (SLE) in all sta tistical models tested, followed by the presence of arthralgias and of high ANA titers (greater than or equal to 1:320). In contrast, low AN A titers as well as anti-dsDNA antibodies showed little or no statisti cal relevance as a criterion for distinction. It seems, therefore, tha t cutaneous LE patients showing signs of nephropathy, presence of arth ralgias and elevated ANA titers (greater than or equal to 1:320) shoul d be carefully monitored, because they may be at risk of developing sy stemic LE involvement.