Ab0669 cutaneous lupus erythematosus over the covid major pandemic period, incidence and clinical characteristics

Background Cutaneous Lupus Erythematosus (CLE) is a chronic inflammatory autoimmune disease with a broad spectrum of clinical manifestations and a variable course, often induced by exogenous factors. CLE is classified in specific and non-specific manifestations with the former divided in acute cutaneous LE (ACLE), subacute cutaneous LE (SCLE), chronic cutaneous LE (CCLE) and intermittent cutaneous LE (ICLE). Objectives To assess clinical features of CLE patients over the major pandemic period and its impact on disease characteristics. Methods Multi-center retrospective study conducted on consecutive CLE outpatients referring to the Rheumatology and Dermatology Units of Tor Vergata Hospital and San Gallicano Institute (Rome, Italy). Inclusion criteria: diagnosis of CLE, age ≥ 18 years, and 4 years continuous follow-up from Mar 2018. Data from every visit performed between Mar ’18 - Feb ’22 were registered for each patient, including: number of visits performed/skipped, demographics, therapy, number of skin flares (yes/no, via BILAG score) and systemic flares (yes/no, SLEDAI-2K increase ≥4 points), type of cutaneous manifestation, Sars-CoV2 infection and SLICC damage index score (SDI). Number of visits, clinical course of disease, occurrence of Sars-CoV2 infection and therapy were compared in two periods: pre-pandemic outbreak (1 Mar 2018-29 Feb 2020) and first-wave pandemic (01 Mar 2020-28 Feb 2022). Results 80 patients were enrolled, 65 females, aged 55.2±14.3 with a disease duration of 32.1±19.8 (Tab 1). In the 1 st period 398 visits were performed while only 180 resulted in 2 nd with a number of visits/patient/year of 1.9 vs 1.1. Skipped and telemedicine visits amounted to 11 and 1 in the 1 st period e to 31 and 21 in 2 nd period respectively. Statistical significant differences emerged in number of documented cutaneous flares: 28 (8.8%) in 1 st period vs 42 (23.3%) in 2 nd (p=0.03). A higher incidence in the 2 nd period of ACLE (15% vs 30%, p<0.01), cutaneous calcinosis (0% vs 10%, p<0.01) and livedo reticularis (10% vs 1.2%, p<0.03) and a lower incidence of CCLE (13% vs 2.5% (p=0.02) were observed compared to the 1 st pre-pandemic period. Although mean SLEDAI-2k resulted significantly lower in the 2 nd period (2.67 vs 2.13, p=0.02) compared to the 1 st one, SLEDAI-2k score related to skin was higher in the 2 nd period compared to the 1 st (0.8 vs 1.1 (p=0.04). A significant reduction in the percentage of patients treated with topical therapy was registered in 2 nd period (p=0.008) while other medications remained stable. 30 patients (37.5%) contracted Sars-CoV2 infection, no differences were registered between patients with infection and those that did not contract infection regarding number of visits, skin and systemic flares, SLEDAI-2K and SDI, therapy and clinical characteristics. Conclusion We reported how the major pandemic period – with general reduction in outpatients’ medical assistance – consisted in a conspicuous increase in cutaneous flares as quantifiable in higher ACLE incidence and reduced topical treatment. At the same time, incidence of systemic flares – along with systemic treatments – remained substantially stable. In conclusion, it appears that patients suffered a burden of cutaneous manifestations after the pandemic period not associated to any systemic impact. References [1]Kuhn A, JDDG; 2007 Table 1. Measures as m±ds and % (n) when appropriate. Patients N=80 p 1st period 2nd period N° cutaneous flares 8.8 (28) 23.3 (42) 0.03 N° systemic flares 27.5 (22) 16.2 (13) - Specific CLE: ACLE 15 (12) 30% (24) 0.03 SCLE 2.5 (2) 6.2 (5) - CCLE 13.7 (11) 2.5 (2) 0.01 Non-specific CLE: Livedo 10 (8) 1.2 (1%) 0.03 Raynaud’s 6.2 (5) 11.2 (9) - Purpura 3.7 (3) 6.2 (5) - Alopecia 15 (12) 6.2 (5) - Cutaneous calcinosis 0 10 (8) 0.001 SLEDAI2K 2.6±1.1 2.1±0.9 0.02 SLEDAI2K skin domains 0.8±0.83 1.1±0.9 0.04 SDI 1.4±1.2 1.1±1.3 - Prednisone, mg 2.6±2 2.8±2.1 - Prednisone 67.5 (54) 63.7 (51) - Topical therapy 31.2 (25) 13.7 (11) 0.008 HCQ 78.7 (63) 80 (64) - csDMARDs 13.7 (11) 8.7 (7) - bDMARDs 6.2 (5) 8.7 (7) - Disclosure of Interests None declared