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Survey: Rheumatologists, dermatologists lack consensus on lupus management

An online survey of dermatologists and rheumatologists managing patients with systemic lupus erythematosus revealed areas of consensus in laboratory studies and also some practice-based differences.

“The study was not designed to assess rationales for different screening approaches formally, but it is possible that dermatologists and rheumatologists treat more patients with disease limited to the skin vs. patients with systemic lupus, respectively,” Lisa M. Arkin, MD, assistant professor in the department of dermatology and pediatrics at the University of Wisconsin Madison School of Medicine and Public Health, and colleagues wrote. “Consequently, this may drive differences in screening and management approaches.”

Previous studies found that 25% to 30% of children with discoid lupus erythematosus (DLE) develop systemic lupus erythematosus (SLE) over a few months to years, according to the researchers.

An online survey was sent to 292 pediatric rheumatologists in the Childhood Arthritis and Rheumatology Research Alliance (CARRA), with a 21% response rate (60 completed surveys), and 200 pediatric dermatologists in the Pediatric Dermatology Research Alliance (PeDRA), of whom 38% responded (76 completed surveys). Clinicians were asked about current clinical practices and management of children with DLE.

The two groups had agreement in the initial screening labs for DLE to include complete blood counts with differential, urinalysis, complement levels, erythrocyte sedimentation rate, antinuclear antibody, hepatic function tests, renal function/electrolytes, double-stranded DNA, Sjögren’s syndrome A, Sjögren’s syndrome B, and Smith and ribonucleoprotein antibodies, according to the study.

The researchers noted evidence of differences in selected disease-modifying risk factors (P = .008).

Hydroxychloroquine as a first-line systemic therapy was agreed upon between groups, but the groups did not agree on a second- or third-line treatment.

Twenty-two rheumatologists (49%) were more likely to always initiate hydroxychloroquine than eight dermatologists (14%; P < .001).

Conversely, 46 dermatologists (81%) were more likely than 15 rheumatologists (33%) to always initiate topical therapy for children with DLE (P < .001).

Researchers found significant differences in perceived risk factors for systemic disease along with substantial differences in screening and treatment of children with DLE, within and across the two specialties.

The researchers added that a multicenter, retrospective PeDRA-CARRA collaborative study is underway to examine the cumulative incidence of SLE in children with DLE to identify clinical outcomes that may be predictors of evolving disease. – by Abigail Sutton

Disclosures: The authors report support from CARRA and the ongoing support of CARRA through the Arthritis Foundation.