Mucocutaneous manifestations in a UK national cohort of juvenile-onset systemic lupus erythematosus patients.

Janet Mcdonagh, Direkrit Chiewchengchol, Ruth Murphy, Thomas Morgan, Steven W Edwards, Valentina Leone, Mark Friswell, Clarissa Pilkington, Kjell Tullus, Satyapal Rangaraj, Janet E McDonagh, Janet Gardner-Medwin, Nick Wilkinson, Phil Riley, Jane Tizard, Kate Armon, Manish D Sinha, Yiannis Ioannou, Rebecca Mann, Kathryn BaileyJoyce Davidson, Eileen M Baildam, Clare E Pain, Gavin Cleary, Liza J McCann, Michael W Beresford

    Research output: Contribution to journalArticlepeer-review


    OBJECTIVE: To determine whether mucocutaneous manifestations are associated with major organ involvement in a UK national cohort of juvenile-onset SLE (JSLE) patients. METHODS: JSLE patients (n = 241) from 15 different centres whose diagnosis fulfilled four or more of the ACR criteria were divided into two groups: those with at least one ACR mucocutaneous criterion (ACR skin feature positive) and those without (ACR skin feature negative) at diagnosis. The relative frequency of skin involvement was described by the paediatric adaptation of the 2004 British Isles Lupus Assessment Group (pBILAG-2004) index. RESULTS: One hundred and seventy-nine patients (74%) had ACR-defined skin involvement with no significant demographic differences compared with those without. ACR skin feature negative patients showed greater haematological (84% vs 67%), renal (43% vs 26%) (P <0.05) and neurological (16% vs 4%) involvement (P = 0.001). Forty-two per cent of ACR skin feature negative patients had skin involvement using pBILAG-2004, which included maculopapular rash (17%), non-scaring alopecia (15%), cutaneous vasculitis (12%) and RP (12%). ACR skin feature negative patients with moderate to severe skin involvement by pBILAG-2004 showed greater renal and haematological involvement at diagnosis and over the follow-up period (P <0.05). Higher immunosuppressive drug use in the skin feature negative group was demonstrated. CONCLUSION: Patients who fulfil the ACR criteria but without any of the mucocutaneous criteria at diagnosis have an increased risk of major organ involvement. The pBILAG-2004 index has shown that other skin lesions may go undetected using the ACR criteria alone, and these lesions show a strong correlation with disease severity and major organ involvement.
    Original languageEnglish
    JournalRheumatology (Oxford, England)
    Issue number8
    Publication statusPublished - Aug 2014


    • ACR criteria
    • disease severity
    • juvenile-onset systemic lupus erythematosus
    • major organ involvement
    • mucocutaneous manifestations
    • pBILAG-2004 index
    • skin involvement


    Dive into the research topics of 'Mucocutaneous manifestations in a UK national cohort of juvenile-onset systemic lupus erythematosus patients.'. Together they form a unique fingerprint.

    Cite this