Mucocutaneous Disease Activity and Damage Accrual in Systemic Lupus Erythematosus: Analyses From the Asia-Pacific Lupus Collaboration Longitudinal Cohort Study.

Abstract

This research article aims to describe the prevalence, associations, and health-related quality of life (HRQoL) impact of mucocutaneous features of systemic lupus erythematosus (SLE). Data from the Asia-Pacific Lupus Collaboration cohort were analyzed (2013-2021). Mucocutaneous activity (MC-A) items were rash, alopecia, and mucosal ulcers; were defined by the Systemic Lupus Erythematosus Disease Activity Index 2000; and were persistent if present for at least six months. Mucocutaneous damage (MC-D) items were chronic skin ulceration, scarring alopecia, and skin/panniculum scarring and were defined by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. HRQoL was measured by 36-Item Short Form Health Survey (SF-36) surveys. Multivariate logistic generalized estimating equation models were used to determine correlates of MC-A at each visit. Time-varying covariate survival models were used to determine predictors of MC-D. During a median of 2.5 (interquartile range 1.0-5.1) years' follow-up, 1,499 of 4,102 patients (36.5%) had MC-A (rash n = 1,055, alopecia n = 731, mucosal ulcers n = 352) and 606 of 3,655 patients (16.6%) had persistent MC-A. These patients were more likely to record worse mean mental (42.6 vs 44.8; P = 0.014) and physical component (41.1 vs 46.1; P < 0.001) SF-36 scores. Being White, smoking, serologic activity, vasculitis, myositis, serositis, nephritis, and neurologic/psychiatric features were correlates of MC-A. Of 3,647 patients, 157 (4.3%) accrued MC-D (skin/panniculum scarring n = 53, alopecia n = 98, ulceration n = 30). These patients had worse mean physical component (39.8 vs 46.0, P = 0.001) SF-36 scores and were more likely to be White with persistent MC-A. All mucocutaneous manifestations were associated with worse HRQoL. MC-A correlated with serologic and systemic disease activity burden in SLE. Persistent MC-A was associated with increased risk of MC-D, emphasizing the importance of early and effective treatment. Both MC-A and MC-D were more likely in White patients, suggesting ethnic and environmental impacts. Smoking was a potentially modifiable correlate of MC-A.