Early discoid lupus erythematosus protects against renal disease in patients with systemic lupus erythematosus: longitudinal data from a large Latin American cohort

Early discoid lupus erythematosus protects against renal disease in patients with systemic lupus erythematosus: longitudinal data from a large Latin American cohort

Author Pons-Estel, G. J. Google Scholar
Aspey, L. D. Google Scholar
Bao, G. Google Scholar
Pons-Estel, B. A. Google Scholar
Wojdyla, D. Google Scholar
Saurit, V. Google Scholar
Alvarellos, A. Google Scholar
Caeiro, F. Google Scholar
Haye Salinas, M. J. Google Scholar
Sato, Emilia Inoue Autor UNIFESP Google Scholar
Soriano, E. R. Google Scholar
Costallat, L. T. L. Google Scholar
Neira, O. Google Scholar
Iglesias-Gamarra, A. Google Scholar
Reyes-Llerena, G. Google Scholar
Cardiel, M. H. Google Scholar
Acevedo-Vasquez, E. M. Google Scholar
Chacon-Diaz, R. Google Scholar
Drenkard, C. Google Scholar
Abstract Objectives The objective of this study was to examine whether early discoid lupus erythematosus (DLE) would be a protective factor for further lupus nephritis in patients with systemic lupus erythematosus (SLE). Methods We studied SLE patients from GLADEL, an inception longitudinal cohort from nine Latin American countries. The main predictor was DLE onset, which was defined as physician-documented DLE at SLE diagnosis. The outcome was time from the diagnosis of SLE to new lupus nephritis. Univariate and multivariate survival analyses were conducted to examine the association of DLE onset with time to lupus nephritis. Results Among 845 GLADEL patients, 204 (24.1%) developed lupus nephritis after SLE diagnosis. Of them, 10 (4.9%) had DLE onset, compared to 83 (12.9%) in the group of 641 patients that remained free of lupus nephritis (hazard ratio 0.39

P=0.0033). The cumulative proportion of lupus nephritis at 1 and 5 years since SLE diagnosis was 6% and 14%, respectively, in the DLE onset group, compared to 14% and 29% in those without DLE (P=0.0023). DLE onset was independently associated with a lower risk of lupus nephritis, after controlling for sociodemographic factors and disease severity at diagnosis (hazard ratio 0.38

95% confidence interval 0.20-0.71). Conclusions Our data indicate that DLE onset reduces the risk of further lupus nephritis in patients with SLE, independently of other factors such as age, ethnicity, disease activity, and organ damage. These findings have relevant prognosis implications for SLE patients and their clinicians. Further studies are warranted to unravel the biological and environmental pathways associated with the protective role of DLE against renal disease in patients with SLE.
Keywords Systemic lupus erythematosus
lupus nephritis
discoid lupus erythematosus
survival analysis
GLADEL cohort
xmlui.dri2xhtml.METS-1.0.item-coverage London
Language English
Sponsor Federico Wilhelm Agricola Foundation Research
Supporting Training Efforts in Lupus for Latin-American Rheumatologists (STELLAR) Program - Rheuminations, Inc.
Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS)-Beca de Formacio i Contractacio de Personal Investigador
National Institutes of Health (NIH)
Centers for Disease Control and Prevention (CDC)
Grant number NIH: R01AR065493
CDC: U01-DP14-004
Date 2017
Published in Lupus. London, v. 26, n. 1, p. 73-83, 2017.
ISSN 0961-2033 (Sherpa/Romeo, impact factor)
Publisher Sage Publications Ltd
Extent 73-83
Origin http://dx.doi.org/10.1177/0961203316651740
Access rights Closed access
Type Article
Web of Science ID WOS:000390847600010
URI https://repositorio.unifesp.br/handle/11600/56507

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