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Digital vasculitis in systemic lupus erythematosus: a minor manifestation of disease activity?

Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas da, São Paulo, Brazil

JF Carvalho

Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas da, São Paulo, Braziljotafc{at}gmail.com

EF Borba

Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas da, São Paulo, Brazil

CTL Borges

Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas da, São Paulo, Brazil

MB Vendramini

Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas da, São Paulo, Brazil

C Bueno

Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas da, São Paulo, Brazil

LP Costa

Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas da, São Paulo, Brazil

E Bonfá

Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas da, São Paulo, Brazil

The objective of this study is to determine if digital vasculitis (DV), a clinical manifestation with a high systemic lupus erythematosus disease activity index (SLEDAI) score, is associated with lupus severity. DV and other clinical manifestations defined according to the SLEDAI were evaluated in 168 consecutive patients with systemic lupus erythematosus (SLE). Two groups were defined according to presence (DV+, n = 27) or absence of DV (DV–, n = 141) at the time of evaluation. The exclusion criterion was the presence of antiphospholipid syndrome (Sapporo’s criteria). The two groups were comparable with regard to age (P = 0.09), gender (P = 1.00), white race (P = 0.81), and disease duration (P = 0.78). Compared to the DV– group, the DV+ group had a significantly higher frequency of mucocutaneous manifestations (66.7 vs. 39.0%, P = 0.01), haematological abnormalities (22.2 vs. 6.4%, P = 0.02) and constitutional symptoms (11.1 vs. 0.7%, P = 0.01). Renal and neurological involvements were similar in both groups (P = 0.57 and P = 1.00, respectively). The evaluation of each SLEDAI parameter confirmed that the DV+ group had higher frequencies of mild manifestations, such as new rash (P = 0.02), alopecia (P = 0.02), oral ulcers (P = 0.045), fever (P = 0.01) and leucopenia (P = 0.005). In contrast, both groups had similarly increased anti-dsDNA (P = 0.78) and decreased complement levels (P = 0.29). In conclusion, DV in patients with SLE identifies a subgroup of a mild disease. The high ‘weighted’ index attributed to this alteration in the SLEDAI score should therefore be revised.

Key Words: activity index • disease activity • SLEDAI • systemic lupus erythematosus • vasculitis

Lupus, Vol. 18, No. 11, 990-993 (2009)
DOI: 10.1177/0961203309106177


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