Estudio transversal del lupus eritematoso cutáneo en el área sanitaria de A Coruña

Resumen

Objectives: To determine epidemiological and clinical characteristics of different subtypes of cutaneous lupus erythematosus (CLE) in the Sanitary Area of A Coruña (SAC). To analyze the prevalence and factors associated with the presence of systemic lupus erythematosus (SLE), activity and damage of skin disease, metabolic syndrome (MS), cardiovascular risk factors (CVR), and health-related quality of life (HRQoL). Methods: Descriptive cross-sectional prevalence study of 260 patients with CLE in the SAC, April 2013-August 2016. The EUSCLE Core Set Questionnaire was used to characterize the patients and the illness. Tobacco consumption (packs/year), Fagerström test, alcohol consumption (g/ day), MS (ATP III, 2001), CVR and the quality of life index in dermatology (DLQI) were determinate in all patients. Results: The most prevalent CLE subsets were discoid LE (DLE) (36.5%) and intermittent (ICLE)/tumidus (LET) (28.5%). 82.7% had only CLE and 17.3% SLE criteria. Patients with CLE without SLE had one decade later onset of the disease and a lower W:M ratio vs SLE (W:M ratio 2:1 vs 8:1). SLE was associated with antinuclear (ANA) > 1/160 (OR: 10.58) and anti-RNP (OR: 32.84) antibodies, whereas the body mass index (BMI) was found to be protective (OR: 0.76). A high activity was related to chronic CLE (CCLE) (OR: 1.98), to be active smoker (OR: 3.04; B: 2.05) and high C-reactive protein (CRP) levels (B: 2.56); while damage was related to activity (B: 0.14). The MS had a lower prevalence in SLE patients than in those having only CLE (22.7% vs. 34.7%) and was associated with BMI (OR: 1.43) and lupus anticoagulant (LA) (OR: 9.78). High CVR was associated with disease duration (OR: 1.40), age (OR: 1.49) and active smoking (OR: 147.18), while female sex resulted a protective factor (OR: 0.10). HRQoL was more affected in women (OR: 3.17) and in patients with elevated disease activity (OR: 1.21) and high nicotine dependence (OR: 10.30). Conclusions: The most prevalent CLE subtypes were DLE and LET. The W:M ratio was lower and the disease onset was later in CLE patients without SLE criteria. The presence of SLE in CLE patients was associated with ANA and anti-RNP positive antibodies, and inversely to the BMI. The cutaneous activity of the LE was related to the CCLE subtype, the active smoking and the increase of the CRP, while the damage was only related to the activity. MS was associated with BMI and LA. RCV was positively associated with duration of LE, age and active smoking, while female sex was protective. HRQoL was more affected in women and in patients with a higher cutaneous activity and high nicotine dependence.