Antibodies to single-stranded DNA in patients with discoid lupus erythematosus

Sera from 31 patients with discoid lupus erythematosus were examined for the presence of antibodies to single-stranded and native DNA. None of these sera had antibodies to native DNA. When rabbit anti-human IgM was used, 6 of 28 patients had elevated binding, whereas only 1 of 29 patients had abnormal binding when antiIgG was used. The IgM nature of this response was confirmed when we demonstrated the binding activity in heavy fractions from gel filtration. We concluded that at least one-fifth of patients with discoid lupus erythematosus have IgM antibodies to single-stranded DNA.     

Vitamin E and discoid lupus erythematosus.

We treated seven patients with discoid lupus erythematosus (DLE) with Vitamin E in an oral dose of 400 mg three times per day for 12 weeks. All other systemic and topical treatments were discontinued 1 month before initiation of the trial. The drug was then stopped and follow-up continued for at least another 4 weeks. No patient showed clearing of lesions. The trial was conducted during summer, when DLE is likely to be most active. There was no deterioration in any patient. No side effects were noted.     

Familial discoid lupus erythematosus associated with heterozygote c2 deficiency

Two siblings with chronic discoid lupus erythematosus and several family members were found with heterozygous C2 deficiency. An association with histocompatibility markers HLA-B 18 and HLA-D w2 was demonstrated, and the slow allotype of factor B was present. Linkage studies in this family suggested a close linkage between the C2 deficiency gene and genes coding for B18, Dw2, and BfS antigens. One HLA-A CB/DBF recombinant was observed showing closer linkage between HLA-D and Bf than between HLA-B and Bf.     

Polyarteritis nodosa developing after discoid lupus erythematosus.

We describe a patient with discoid lupus erythematosus whose pattern of disease evolved into a systemic vasculitis polyarteritis nodosa.     

The dynamism of cutaneous lupus erythematosus: mild discoid lupus erythematosus evolving into SLE with SCLE and treatment-resistant lupus panniculitis

We present a 47-year-old Caucasian female who initially presented with mild discoid lupus erythematosus that evolved into systemic lupus erythematosus with subacute cutaneous LE and treatment-recalcitrant lupus panniculitis. Conventional therapy with antimalarials, systemic steroids, azathioprine, cyclophosphamide, methotrexate, and pulse doses of methylprednisolone did not control the course of the disease. Cyclosporin-A treatment led to clinical improvement and maintained remission.     

Acute lumbosacral polyradiculoneuropathy heralding transformation to systemic lupus erythematosus in a patient with discoid lupus

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease with which a variety of neuropathic disorders have been associated. Among these, the acute inflammatory demyelinating polyradiculoneuropathy variant of Guillain-Barré syndrome has been well established. However, acute axonal lumbosacral polyradiculoneuropathy accompanied by albuminocytological dissociation in the cerebrospinal fluid has been extremely rarely reported in SLE. We report on a 47-year-old woman with discoid lupus presenting with acute onset of flaccid paraplegia. Extensive investigations suggested the diagnoses of axonal lumbosacral polyradiculoneuropathy and SLE. Treatment with intravenous methylprednisolone and cyclophosphamide resulted in clinical recovery. Development of immune-mediated polyneuropathy in a patient with discoid lupus should forewarn the clinician regarding transformation into the systemic form of the disease.     

Association of discoid lupus erythematosus with clinical manifestations and damage accrual in a multiethnic lupus cohort

Objective

To determine the clinical manifestations and disease damage associated with discoid rash in a large multiethnic systemic lupus erythematosus (SLE) cohort.

Methods

SLE patients (per American College of Rheumatology [ACR] criteria) ages ≥16 years with a disease duration of ≤10 years at enrollment and defined ethnicity (African American, Hispanic, or white) from a longitudinal cohort were studied. Socioeconomic–demographic features, clinical manifestations, and disease damage (per the Systemic Lupus International Collaborating Clinics/ACR Damage Index) were determined. The association of discoid lupus erythematosus (DLE) with clinical manifestations and disease damage was examined using multivariable logistic regression.

Results

A total of 2,228 SLE patients were studied. The mean ± SD age at diagnosis was 34.3 ± 12.8 years and the mean ± SD disease duration was 7.9 ± 6.0 years; 91.8% were women. DLE was observed in 393 patients with SLE (17.6%). In the multivariable analysis, patients with DLE were more likely to be smokers and of African American ethnicity and to have malar rash, photosensitivity, oral ulcers, leukopenia, and vasculitis. DLE patients were less likely to be of Hispanic (from Texas) ethnicity and to have arthritis, end‐stage renal disease, and antinuclear, anti–double‐stranded DNA, and antiphospholipid antibodies. Patients with DLE had more damage accrual, particularly chronic seizures, scarring alopecia, scarring of the skin, and skin ulcers.

Conclusion

In this cohort of SLE patients, DLE was associated with several clinical features, including serious manifestations such as vasculitis and chronic seizures.     

Anti-DNA antibodies in discoid lupus erythematosus. Follow-up study.

Anti-DNA antibodies have been detected previously in patients with chronic discoid lupus erythematosus (DLE) despite the absence of overt systemic manifestations. 27 patients with DLE were followed up 3 years after the detection of anti-DNA antibodies in 7. None had developed other features of systemic lupus erythematosus. We conclude that the occasional finding of anti-DNA antibodies in patients with DLE does not predict those likely to develop systemic disease.     

Anticardiolipin antibodies and antiphospholipid syndrome in chronic discoid lupus erythematosus

Summary Anticardiolipin antibodies (aCL) of immunoglobulin (Ig) G and M classes were determined in 28 patients affected with chronic discoid lupus erythematosus (CDLE), comparing their prevalence and levels to those in 60 healthy subjects matched for age and sex. A high and significant frequency of IgG (67.8%) and IgM (50.0%) aCL together with prevalence of high antibody levels was found in CDLE patients, while healthy controls had IgG and IgM aCL in 1.6% and 3.3% of cases respectively. Clinical features in keeping with the diagnosis of antiphospholipid syndrome were found in one patient (3.5%), which, as the first manifestation of the syndrome, showed a pulmonary thromboembolism which appeared some days after prolonged exposure to the sun. These results provide additional data on autoimmune phenomena in CDLE and suggest that aCL test should be considered as useful aids in immunological diagnosis of CDLE.     

Squamous cell carcinoma of the skin in black patients with discoid lupus erythematosus

Skin cancer is relatively uncommon among black individuals. Squamous cell carcinoma occurred in a scar of chronic discoid lupus erythematosus in a black patient. A review of 7 previously reported cases of squamous cell carcinoma in blacks with chronic discoid lupus erythematosus indicates a tendency of the cancer to metastasize. Sun exposure of the hypopigmented lesions of chronic discoid lupus and possibly other factors predispose to cancer of the skin. Poorly healing skin lesions in chronic discoid lupus should arouse suspicion of malignant change.     

The expression of C3b receptors in the differentiation of discoid lupus erythematosus and systemic lupus erythematosus

We studied the expression of the C3b receptor, CR1, on erythrocytes (E-CR1) of patients who, in spite of having mild systemic symptoms, were diagnosed as having discoid lupus erythematosus and followed accordingly. We found that E-CR1 was markedly reduced in these patients, similar to that seen in patients with systemic disease. In contrast, those patients with completely asymptomatic discoid lupus erythematosus had the same expression of E-CR1 as the normal population.