Cutaneous vasculitis manifestations in patients with systemic lupus erythematosus: a comprehensive retrospective analysis with clinical implications

INTRODUCTION: Systemic lupus erythematosus (SLE) is an autoimmune disease with clinical and laboratory heterogeneity. Data on cutaneous vasculitis (CV) in SLE are limited, especially in the context of its clinical value. OBJECTIVES: This study aimed to compare the clinical characteristics, laboratory findings, and treatment patterns of SLE individuals with and without CV to determine if skin vasculitis identified a distinct subset of patients with unique outcomes. PATIENTS AND METHODS: We conducted a retrospective analysis based on medical records of 1021 SLE patients (64 with CV and 957 without CV) treated at the University Hospital in Kraków, Poland, between 2012 and 2022. All patients met the 2019 European Alliance of Associations for Rheumatology / American College of Rheumatology classification criteria for SLE. RESULTS: Overall, CV was observed in 6.27% of the study cohort (n = 64). The patients with CV more often exhibited constitutional symptoms (87.5% vs 76.2%; P = 0.04), joint manifestations (96.9% vs 87.3%; P = 0.02), central nervous system (CNS) involvement (15.6% vs 6.6%; P = 0.007), and heart failure (14.1% vs 4.4%; P <0.001), as compared with the individuals without CV. Higher prevalence of anti-Sjögren syndrome type A (75% vs 59.2%; P = 0.02) and antiribonucleoprotein antibodies (35% vs 20.3%; P = 0.007) was observed in the CV group. Treatment involved more frequent use of azathioprine (51.6% vs 37.5%; P = 0.03), belimumab (9.4% vs 3.7%; P = 0.03), and cyclophosphamide (40.6% vs 27.5%; P = 0.02) in the individuals with CV, as compared with those without CV. CONCLUSIONS: SLE patients with CV present with more severe disease, including heart failure and CNS involvement, and a specific autoantibody profile. These individuals may require more aggressive immunosuppressive treatment. Our findings suggest that CV in SLE may serve as a marker of more severe disease, necessitating careful monitoring and more intensive treatment.