Mucocutaneous Disease Activity and Damage Accrual in Systemic Lupus Erythematosus: Analyses From the Asia‐Pacific Lupus Collaboration Longitudinal Cohort Study

OBJECTIVE: This research article aims to describe the prevalence, associations, and health-related quality of life (HRQoL) impact of mucocutaneous features of systemic lupus erythematosus (SLE). METHODS: Data from the Asia-Pacific Lupus Collaboration cohort were analyzed (2013-2021). Mucocutaneous activity (MC-A) items were rash, alopecia, and mucosal ulcers; were defined by the Systemic Lupus Erythematosus Disease Activity Index 2000; and were persistent if present for at least six months. Mucocutaneous damage (MC-D) items were chronic skin ulceration, scarring alopecia, and skin/panniculum scarring and were defined by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. HRQoL was measured by 36-Item Short Form Health Survey (SF-36) surveys. Multivariate logistic generalized estimating equation models were used to determine correlates of MC-A at each visit. Time-varying covariate survival models were used to determine predictors of MC-D. RESULTS: During a median of 2.5 (interquartile range 1.0-5.1) years' follow-up, 1,499 of 4,102 patients (36.5%) had MC-A (rash n = 1,055, alopecia n = 731, mucosal ulcers n = 352) and 606 of 3,655 patients (16.6%) had persistent MC-A. These patients were more likely to record worse mean mental (42.6 vs 44.8; P = 0.014) and physical component (41.1 vs 46.1; P < 0.001) SF-36 scores. Being White, smoking, serologic activity, vasculitis, myositis, serositis, nephritis, and neurologic/psychiatric features were correlates of MC-A. Of 3,647 patients, 157 (4.3%) accrued MC-D (skin/panniculum scarring n = 53, alopecia n = 98, ulceration n = 30). These patients had worse mean physical component (39.8 vs 46.0, P = 0.001) SF-36 scores and were more likely to be White with persistent MC-A. CONCLUSION: All mucocutaneous manifestations were associated with worse HRQoL. MC-A correlated with serologic and systemic disease activity burden in SLE. Persistent MC-A was associated with increased risk of MC-D, emphasizing the importance of early and effective treatment. Both MC-A and MC-D were more likely in White patients, suggesting ethnic and environmental impacts. Smoking was a potentially modifiable correlate of MC-A.

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Journal
Arthritis Care & Research
Published
2026-04-06
DOI
https://doi.org/10.1002/acr.80050
Primary Topic
Systemic Lupus Erythematosus Research
Type
article
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article

Mucocutaneous Disease Activity and Damage Accrual in Systemic Lupus Erythematosus: Analyses From the Asia‐Pacific Lupus Collaboration Longitudinal Cohort Study

Chak Sing Lau, Cherica Tee, Masayoshi Harigai, Yih Jia Poh et al.
Arthritis Care & Research
Systemic Lupus Erythematosus Research
article

Mucocutaneous Disease Activity and Damage Accrual in Systemic Lupus Erythematosus: Analyses From the Asia‐Pacific Lupus Collaboration Longitudinal Cohort Study

Chak Sing Lau, Cherica Tee, Masayoshi Harigai, Yih Jia Poh, Y. Kaneko, Geraldine Hassett, Mark Sapsford, Nicola Tugnet, Madelynn Chan, Naoaki Ohkubo, Vera Golder, Y. Hao, Yi‐Hsing Chen, Rangi Kandane‐Rathnayake, Aisha Lateef, Shue Fen Luo, Yeong-Jian Jan Wu, Sean O'Neill, Dylan Hansen, BMDB Basnayake, Yoshiya Tanaka, Eric Morand, Zhuoli Zhang, Sargunan Sockalingam, Fiona Goldblatt, Jiacai Cho, Leonid Zamora, Michael Tee, Shirley Chan, Shereen Oon, Kristine(Pek Ling) Ng, Sang‐Cheol Bae, Mandana Nikpour, Laniyati Hamijoyo, Jun Kikuchi, Sandra Navarra, Yasuhiro Katsumata, Hai‐hong Yao, Alberta Hoi, Worawit Louthrenoo, Tsutomu Takeuchi, Zhanguo Li
article en

Abstract

OBJECTIVE: This research article aims to describe the prevalence, associations, and health-related quality of life (HRQoL) impact of mucocutaneous features of systemic lupus erythematosus (SLE). METHODS: Data from the Asia-Pacific Lupus Collaboration cohort were analyzed (2013-2021). Mucocutaneous activity (MC-A) items were rash, alopecia, and mucosal ulcers; were defined by the Systemic Lupus Erythematosus Disease Activity Index 2000; and were persistent if present for at least six months. Mucocutaneous damage (MC-D) items were chronic skin ulceration, scarring alopecia, and skin/panniculum scarring and were defined by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. HRQoL was measured by 36-Item Short Form Health Survey (SF-36) surveys. Multivariate logistic generalized estimating equation models were used to determine correlates of MC-A at each visit. Time-varying covariate survival models were used to determine predictors of MC-D. RESULTS: During a median of 2.5 (interquartile range 1.0-5.1) years' follow-up, 1,499 of 4,102 patients (36.5%) had MC-A (rash n = 1,055, alopecia n = 731, mucosal ulcers n = 352) and 606 of 3,655 patients (16.6%) had persistent MC-A. These patients were more likely to record worse mean mental (42.6 vs 44.8; P = 0.014) and physical component (41.1 vs 46.1; P < 0.001) SF-36 scores. Being White, smoking, serologic activity, vasculitis, myositis, serositis, nephritis, and neurologic/psychiatric features were correlates of MC-A. Of 3,647 patients, 157 (4.3%) accrued MC-D (skin/panniculum scarring n = 53, alopecia n = 98, ulceration n = 30). These patients had worse mean physical component (39.8 vs 46.0, P = 0.001) SF-36 scores and were more likely to be White with persistent MC-A. CONCLUSION: All mucocutaneous manifestations were associated with worse HRQoL. MC-A correlated with serologic and systemic disease activity burden in SLE. Persistent MC-A was associated with increased risk of MC-D, emphasizing the importance of early and effective treatment. Both MC-A and MC-D were more likely in White patients, suggesting ethnic and environmental impacts. Smoking was a potentially modifiable correlate of MC-A.

Arthritis Care & Research
University of Santo Tomas Hospital (PH), The University of Sydney (AU), University Malaya Medical Centre (MY), The University of Melbourne (AU), Chang Gung University (TW), University of Occupational and Environmental Health Japan (JP), Peking University (CN), Keio University (JP), Singapore General Hospital (SG), Royal Prince Alfred Hospital (AU), Middlemore Hospital (NZ), Queen Mary Hospital (CN), Liverpool Hospital (AU), Monash Medical Centre (AU), Tan Tock Seng Hospital (SG), Teaching Hospital Kandy (LK), Flinders Medical Centre (AU), UNSW Sydney (AU), Dr. Hasan Sadikin General Hospital (ID), St Vincent's Hospital Melbourne (AU), Taichung Veterans General Hospital (TW), Greenlane Clinical Centre (NZ), Waitemata District Health Board (NZ), Peking University People's Hospital (CN), Peking University First Hospital (CN), Tokyo Women's Medical University (JP), Hanyang University Seoul Hospital (KR), Woodlands Health Campus (SG), National University Hospital (SG), Tissue Dynamics (Israel) (IL), University College London (GB), Chiang Mai University (TH), Monash University (AU), University of the Philippines Manila (PH), Saitama Medical University (JP), University of Hong Kong (HK)
Good health and well-being
Openalex Percentile: Top 36%
Systemic Lupus Erythematosus Research
DOISourceOpenAlex
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