Immunological Correlation in Different Cutaneous Clinical Types of Lupus Erythematosus in the Bulgarian Population.

Introduction: Lupus erythematosus is an autoimmune disorder with various clinical manifestations. Depending on the clinical-immunological correlation different variants with a variable prognosis, multiple strategies for therapy and follow-up are described. Moreover, a regular immunological monitoring could help for a timely established aggravation of the disease from localized to systemic form. The aim of preset study was to analyze the antibody profile of patients with cutaneous manifestations in different subtypes of lupus erythematosus.

Methods: Sixty-seven Bulgarian patients with different clinical variants of lupus erythematosus, admitted in the Department of Dermatology in Alexandrovska University Hospital in Sofia between October 2017 and May 2021 were investigated and their data were compared to those of 63 persons control group. Several immune-serological markers as ANA, anti-dsDNA, anti-Sm, anti-SM/RNP, anti-histone, anti-C1q, anti-SSA/Ro, anti-SSA/Ro52, anti-SSA/Ro60 and anti-SSB/La were used. Statistical analysis was performed using the parametric analysis with SPSS for Windows 21.0 (IBM, SPSS statistics) software and receiver operating characteristic (ROC) curve and the area under the curve (AUC) analysis by MedCalc for Windows, version 20.0.23 statistical software.

Results: A statistical significance (p<0.05) was found in all serological markers in LE comparing to the control group. Anti-C1q (p=0.06) had a tendency for a significance in the context of subacute cutaneous LE.Anti-SSA/Ro 52 and anti-SSA/Ro 60 were found to prevail significantly in patients with chronic cutaneous LE. Anti-dsDNA, anti-Sm, anti-Sm/RNP (p<0.05) were related straightly with systemic LE. All patients in our research with higher than 1:320 titers of ANA are found to have bad disease control.

Discussion: Our data confirmed the strong association between anti-dsDNA, anti-Sm, anti-Sm/RNP and SLE, as well as anti-SSA/Ro 52 and anti-SSA/Ro 60 and subacute cutaneous LE. ANA is a relevant marker of lupus disease activity. All lupus patients with ANA higher than 320 titter had a bad disease control. Based on our results, ANA and anti-SSB/La could be used as follow-up markers for a disease conversion form CLE to SLE. Anti-SSB/La antibodies are found in higher prevalence in patients with discoid cutaneous LE.