Initial digital vasculitis in a large multicenter cohort of childhood‐onset systemic lupus erythematosus

Made available in DSpace on 2018-12-11T17:16:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-11-01 Objectives To assess clinical digital vasculitis (DV) as an initial manifestation of childhood‐onset systemic lupus erythematosus (cSLE) within a large population. Methods Multicenter cross‐sectional study including 852 cSLE patients (ACR criteria) followed in ten Pediatric Rheumatology centers in São Paulo State, Brazil. Results DV was observed in 25/852 (3%) cSLE patients. Periungual hemorrhage was diagnosed in 12 (48%), periungual infarction in 7 (28%), tip finger ulceration in 4 (16%), painful nodules in 1 (4%) and gangrene in 1 (4%). A poor outcome, with digital resorption, occurred in 5 (20%). Comparison of patients with and without DV revealed higher frequency of malar rash (80% vs. 53%, p = 0.008), discoid rash (16% vs. 4%, p = 0.017), photosensitivity (76% vs. 45%, p = 0.002) and other cutaneous vasculitides (80% vs. 19%, p < 0.0001), whereas the frequency of overall constitutional features (32% vs. 61%, p = 0.003), fever (32% vs. 56%, p = 0.020) and hepatomegaly (4% vs. 23%, p = 0.026) were lower in these patients. Frequency of female gender, severe multi‐organ involvement, autoantibodies profile and low complement were alike in both groups (p > 0.05). SLEDAI‐2 K median, DV descriptor excluded, was significantly lower in patients with DV compared to those without this manifestation [10(0‐28) vs. 14(0‐58), p = 0.004]. Visceral vasculitis or death were not observed in this cSLE cohort. The frequency of cyclophosphamide use (0% vs. 18%, p = 0.014) was significantly lower in the DV group. Conclusion Our large multicenter study identified clinical DV as one of the rare initial manifestation of active cSLE associated with a mild multisystemic disease, in spite of digital resorption in some of these patients. Universidade Federal de São Paulo (Unifesp) Unidade de Reumatologia Pediátrica Universidade de São Paulo (USP) Faculdade de Medicina Unidade de Reumatologia Pediátrica Universidade de São Paulo (USP) Faculdade de Medicina Divisão de Reumatologia Universidade Estadual Paulista (Unesp) Faculdade de Medicina de Botucatu Hospital das Clínicas de Botucatu Universidade Estadual Paulista (Unesp) Faculdade de Medicina de Botucatu Hospital das Clínicas de Botucatu