Descriptive characteristics of lupus and vasculitis-like events
| Characteristics | nbDMARD cohort n (%) | TNFi cohort n (%) | Characteristics | nbDMARD cohort n (%) | TNFi cohort n (%) |
|---|---|---|---|---|---|
| Lupus-like events | Vasculitis-like events | ||||
| Limited to cutaneous manifestations only Cutaneous involvement (all) Malar rash Discoid rash Photosensitive rash SCLE rash Other† Missing description‡ Alopecia Mouth ulcers Constitutional symptoms Serositis (pericardial/pulmonary involvement) New arthralgia§ Haematological involvement Neurological involvement Renal involvement New ANA-positive Anti-dsDNA-positive Low complement (C3/C4) Antiphospholipid antibodies-positive ACR SLE criteria met SLICC SLE criteria met | 3 (60) 4 (80) 2 (50) 1 (25) – 1 (25) – – – 1 (20) 1 (20) – 2 (40) – – 1 (20) 4 (80) 2 (40) – – 1 (20) 2 (40) | 30 (55.5) 48 (89) 6 (12.5) 8 (16.7) 8 (16.7) 2 (4.1) 17 (35.4) 7 (14.6) 7 (13.0) 5 (9.2) 6 (11.1) 4 (7.4) 10 (18.5) 5 (9.3) 2 (3.7) 4 (7.4) 30 (55.6) 12 (22.2) 5 (9.3) 1 (1.9) 9 (16.7) 11 (20.0) | Limited to cutaneous manifestations only (included urticarial, bullous, purpuric and ulcerating lesions) *Systemic involvement Digital ischaemia Nailfold vasculitis Neurological involvement (small vessel vasculitis confirmed on sural biopsy; mononeuritis multiplex) Respiratory involvement (including cavitating lung lesions; pneumonitis and pulmonary emboli) ENT Renal involvement Ocular involvement (including temporal branch retinal vein occlusion of vasculitis type and episcleritis) Associated thromboembolism ANCA-positive Requiring IV methylprednisolone +/−cyclophosphamide | 9 (64.3) 5 (35.7) 2 (14.3) – 1 (7.1) – – – 1 (7.1) – – 1 (7.1) | 51 (63.0) 30 (37.0) 11 (13.6) 14 (17.3) 6 (7.4) 6 (7.4) 3 (3.7) 2 (2.5) 2 (2.5) 4 (4.9) 5 (6.2) 10 (12.3) |
*Systemic involvement in VLE cases refers to extra-cutaneous involvement outlined below. In the VLE cases, ANCA status was not checked or reported in the majority of cases, with five patients with known positive status during the event (four patients pANCA-positive/MPO −ve and one patient cANCA-positive, PR3-positive).
†Other rashes included maculopapular, bullous, chilblain lupus rashes.
‡Patients with missing details regarding their cutaneous involvement were reported as ‘cutaneous lupus’ by the treating physician in conjunction with other lupus manifestations. Other positive serology detected in TNFi-treated patients with LLE included anti-Ro/La antibodies, antiribonucleoprotein (RNP) antibodies, perinuclear antineutrophil cytoplasmic antibodies (pANCA) positivity, antihistone antibodies in one patient each.
§No cases were classified as LLE solely on the basis of being ANA-positive and new arthralgia. All such cases developed arthralgia and other SLE manifestations concomitantly.
ACR, American College of Rheumatology; ANA, antinuclear antibodies; dsDNA, double-stranded DNA; nbDMARDs, non-biological disease-modifying antirheumatic drugs; ENT, ear, nose and throat;SCLE, subacute cutaneous lupus erythematosus; SLE, systemic lupus erythematosus; SLICC, Systemic Lupus International Collaborating Clinics; TNFi, tumour necrosis factor-α inhibitor.