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Abstract

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune systemic disease which symptoms induced by Ultraviolet rays exposure. It commonly affects women and causes wide range of symptoms. One of the organs affected is mucocutaneous. Our study aims to determine mucocutaneous manifestations of SLE patients in Rheumatology Outpatient Clinic in Dr.Hasan Sadikin General Hospital, Bandung.

Methods: A descriptive study with prospective crosssectional design conducted. Data were obtained by interviewing SLE patients as primary data and accessing medical record as secondary data. Ninety-six SLE patients met the inclusion and exclusion criteria were
included.

Results: From ninety-six subjects, 94.8% subjects are working indoors. Mucocutaneous manifestation were found in most patients. Based on American College of Rheumatology (ACR) criteria, we found mucocutaneous manifestations, such as: oral ulcers in 67 patients
(69.8%); malar rash in 63 patients (65.6%); photosensitivity rash in 51 patients (53.1%), and discoid rash erythematous in 21 patients (21.9%). Specific SLE cutanoeus manifestation based on Gilliam classification were found in our study subjects, such as papulosquamous/ psoriasisform (19.5%) , morbilliform (17.7%), vesicobullous annular SCLE (13.5%), annular SCLE (6.3%), and TEN-like LE (1%). Non-specific LE cutaneous
manifestations based on Gilliam classification were also found in our study subjects, such as oral ulcers (69.8%), photosensitivity rash (53.1%), alopecia (86.5%), Raynaud’s Phenomenon (39.6%), nail abnormalities (24.0%), periungual telangiectasia patients (13.5%), vasculitic lesions (12.5%), thrombophlebitis (44.8%), bullous lesion (5.2%) and erythema multiforme (5.2%).

Conclusion: Mucocutaneous manifestations in SLE patients based on ACR criteria found most in this study is oral ulcers. Based on Gilliam classification specific LE cutanoeus manifestation was not found in all SLE patients, while non-specific LE mucocutaneous manifestations mostly found is alopecia.

Keywords: American College of Rheumatology (ACR) criteria, Gilliam classification, Mucocutaneous manifestations, Systemic Lupus Erythematosus

Article Details

How to Cite
Veimern, C. A., Sungkar, E., Dharmadji, H. P., & Hamijoyo, L. (2018). Mucocutaneous Manifestation of Systemic Lupus Erythematosus Patients At Rheumatology Outpatient Clinic In Dr. Hasan Sadikin General Hospital. Indonesian Journal of Rheumatology, 9(1). https://doi.org/10.37275/ijr.v9i1.65

References

  1. Frieri M, Heuser W, Bliss J. Efficacy of novel monoclonal antibody belimumab in the treatment of lupus nephritis. Journal of pharmacology & pharmacotherapeutics. 2015; 6(2):71-6.
  2. Wallace DJ, Kalunian K, Petri MA, Strand V, Houssiau FA, Pike M, et al. Efficacy and safety of epratuzumab in patients with moderate/severe active systemic lupus erythematosus: results from EMBLEM, a phase IIb, randomised, double-blind, placebo-controlled, multicentre study. Annals of the rheumatic diseases. 2014;73(1):183-90.
  3. Jakes RW, Bae S-C, Louthrenoo W, Mok C-C, Navarra SV, Kwon N. Systematic review of the epidemiology of systemic lupus erythematosus in the Asia-Pacific region: prevalence, incidence, clinical features, and mortality. Arthritis Care & Research. 2012; 64(2):159-68.
  4. Rees F, Doherty M, Grainge M, Davenport G, Lanyon P, Zhang W. The incidence and prevalence of systemic lupus erythematosus in the UK, 1999-2012. Annals of the rheumatic diseases. 2016;75(1):136-41.
  5. Danza A, Ruiz-Irastorza G. Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies. Lupus. 2013;22(12):1286-94.
  6. Hahn BH. The Pathogenesis of SLE. In: Wallace DJ, Hahn B, editors. Dubois’ lupus erythematosus and related syndromes. Philadelphia: Elsevier Saunders; 2012. p. 25-34.
  7. Crow MK. Systemic Lupus Erythematosus. In: Goldman L, Schafer AI, editors. Goldman-Cecil Medicine. 25 ed. Philadelphia: Saunders; 2016. p. 1768-77.
  8. Yazdany J, Dall’Era M. Definition and classification of lupus and lupusrelated disorders. In: Wallace DJ, Hahn B, editors. Dubois’ lupus erythematosus and related syndromes. 8th ed. Philadelphia: Elsevier Saunders; 2012. p. 1-7.
  9. Kaplan MJ. Neutrophils in the pathogenesis and manifestations of SLE. Nat Rev Rheumatol. 2011;7(12):691-9.
  10. Denny MF, Yalavarthi S, Zhao W, Thacker SG, Anderson M, Sandy AR, et al. A distinct subset of proinflammatory neutrophils isolated from patients with systemic lupus erythematosus induces vascular damage and synthesizes type I IFNs. Journal of immunology (Baltimore, Md : 1950). 2010;184(6):3284-97.
  11. Mary K. Crow TBN, and Kyriakos A. Kirou. Cytokines and interferons in Lupus. In: Wallace DJ, Hahn B, editors. Dubois’ lupus erythematosus and related syndromes. Philadelphia: Elsevier Saunders; 2012. p. 74-87.
  12. Sullivan S. Development of a Systemic Lupus Erythematosus Knowledge Questionnaire: The Relationship Among Disease Proximity, Educational Exposure and Knowledge. 2016.
  13. Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD. Manifestations of Systemic Lupus Erythematosus. Mædica. 2011;6(4):330-6.
  14. Petri M, Orbai A-M, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis & Rheumatism. 2012;64(8):2677-86.
  15. Saigal R, Kansal A, Mittal M, Singh Y, Maharia HR, Juneja M. Clinical profile of systemic lupus erythematosus patients at a tertiary care centre in Western India. J Indian Acad Clin Med. 2011;13:27-32.
  16. Das NK, Dutta RN, Sengupta SR. Skin lesions in lupus erythematosus: a marker of systemic involvement. Indian journal of dermatology. 2011;56(5):537.
  17. Fenner J, Clark RA. Anatomy, Physiology, Histology, and Immunohistochemistry of Human Skin. Skin Tissue Engineering and Regenerative Medicine. 2016:1.
  18. Danza A, Ruiz-Irastorza G. Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies. Lupus. 2013;22(12):1286-94.
  19. Costner MI, Sontheimer RD. Lupus Erythematosus. In: Lowell A. Goldsmith M, Mph, Stephen I. Katz M, Phd, Barbara A. Gilchrest M, Amy S. Paller M, David J. Leffell M, Klaus Wolff M, Frcp, editors. Fitzpatrick’s Dermatology in General Medicine. 2: The McGraw-Hill Companies, Inc; 2012. p. 1909-25.
  20. Szczęch J, Rutka M, Samotij D, Zalewska A, Reich A. Clinical characteristics of cutaneous lupus erythematosus. Postepy dermatologii i alergologii. 2016;33(1):13-7.
  21. Chong BF, Werth VP. Skin disease in cutaneous lupus erythematosus. In: Wallace DJ, Hahn B, editors. Dubois’ lupus erythematosus and related syndromes. Philadelphia: Elsevier Saunders; 2012. p. 319-32.
  22. Grönhagen CM, Nyberg F. Cutaneous lupus erythematosus: An update. Indian dermatology online journal. 2014;5(1):7.
  23. Budhoo A, Mody G, Dubula T, Patel N, Mody P. Comparison of ethnicity, gender, age of onset and outcome in South Africans with systemic lupus erythematosus. Lupus. 2016:0961203316676380.
  24. Gupta B, Bhandari A, Saha M, Madhab V. A Clinical Study Of Pattern Of Skin Manifestations In Patients With Systemic Lupus Erythematosus Attending Dermatology Opd In A Tertiary Care Centre. Journal Of Evolution Of Medical And Dental Sciences-Jemds. 2016;5(47):3084-7.
  25. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams Obstetrics 24th ed: McGraw Hill Professional; 2014. 1358p.
  26. Mak A, Tay S. Environmental Factors, Toxicants and Systemic Lupus Erythematosus. International Journal of Molecular Sciences. 2014;15(9):16043.
  27. Kole AK, Ghosh A. Cutaneous Manifestations Of Systemic Lupus Erythematosus In A Tertiary Referral Center. Indian Journal of Dermatology. 2009;54(2):132-6.
  28. Kuhn A, Landmann A. The classification and diagnosis of cutaneous lupus erythematosus. Journal of Autoimmunity. 2014;48–49:14-9.
  29. Yu J, Brandling-Bennett H, Co DO, Nocton JJ, Stevens AM, Chiu YE. Toxic Epidermal Necrolysis-Like Cutaneous Lupus in Pediatric Patients: A Case Series and Review. Pediatrics. 2016;137(6)