Chilblain lupus erythematosus is associated with antibodies to SSA/Ro

Abstract

Chilblain lupus erythematosus (CL) of Hutchinson is a subtype of lupus erythematosus (LE) characterized by erythematous lesions induced by cold, damp climates. A number of patients affected by CL eventually develop features of systemic lupus erythematosus (SLE).We report here 9 patients with chilblain cutaneous lesions, 6 of them were affected by SLE and 2 by SCLE. The onset of CL preceded the diagnosis of LE, from 1 to 10 years in 3 cases, it was concurrent in one case and was subsequent in the remaining 4 cases. Raynaud's phenomenon and photosensitivity were other prominent clinical features in patients with CL. Nailfold capillaroscopy revealed pathological changes in every patient examined. ANA and anti-SSA/Ro antibodies were detected in all nine patients. Anti-SSB/La were detected in 2 cases, anti-Sm in one case, and anti Sm and anti-RNP in a one case. Antibodies to dsDNA and complement consumption were found in the six patients with SLE. The fine specificity of anti-SSA/Ro was determined by immunoblotting: anti-60kD and anti-52 kD were detected in three sera, anti-60kD alone in 5 sera, while one serum did not blot.

In conclusion, the present study suggests that chilblain LE is associated with SSA/Ro autoantibodies, as is SCLE, hypergammaglobulinemic purpura and neonatal lupus erythematosus.

Keywords

chilblain lupus antinuclear antibodies anti-SSa/Ro antibodies nailfold capillaroscopy

Get full access to this article

View all access options for this article.

References

Hutchinson J . Harveian lectures on lupus . The varieties of common lupus. Br Med J 1888; 1: 58–63 .

Aoki T , Ishizawa T , Hozumi Y et al. Chilblain lupus erythematosus of Hutchinson responding to surgical treatment: a report of two patients with anti-Ro/SS-A antibodies . Br J Dermatol 1996; 134: 533–537 .

Crowson AN , Magro CM . Idiopathic perniosis and its mimics: A clinical and histopathological study of 38 cases . Human Pathology 1997; 28: 478–484 .

Su WP , Perniciaro C , Rogers RS 3rd , White JW Jr. Chilblain lupus erythematosus (lupus pernio): Clinical review of the Mayo Clinic experience and proposal of diagnostic criteria . Cutis 1994; 54: 395–399 .

Bernstein RM , Bunn CC , Hughes GRV . Identification of antibodies to acidic antigens by counterimmunoelectrophoresis . Ann Rheum Dis 1982; 41: 554–555 .

Yell JA , Mbuagbaw J , Burge SM . Cutaneous manifestations of systemic lupus erythematosus . Br J Dermatol 1996; 135: 355–362 .

Doutre MS , Beylot C , Beylot J et al. Chilblain lupus erythematosus: report of 15 cases . Dermatology 1992; 184: 26–28 .

Millard LG , Rowell NR . Chilblain lupus erythematosus (Hutchinson). A clinical and laboratory study of 17 patients . Br J Dermatol 1978; 98: 497–506 .

Maddision PJ , Mogavero H , Provost TT et al. The clinical significance of autoantibodies to a soluble cytoplasmic antigen in Systemic Lupus Erythematosus and other connective tissue disease . J Rheumatol 1979; 6: 189–195 .

10.

Mond CH , Peterson MGE , Rothfield NF . Correlation of anti-Ro antibody with photosensitivity rash in Systemic Lupus Erythematosus patients . Arthritis Rheum 1989; 32: 202–204 .

11.

Reichlin M , van Venrooij WJ . Autoantibodies to URNP particles. Relationship to clinical diagnosis and nephritis . Clin Exp Immunol 1991; 83: 286–290 .

12.

Morioka N , Tsuchida T , Ueda Y et al. Evaluation of the past history of chilblain in cases of systemic lupus erythematosis (SLE) and its similar diseases . Nippon Hifuka Gakkai Zasshi 1991; 101: 615–622 .

13.

de Argila Fernandez-Auran D , Revenga Arranz F , Iglesias Diez L . Perniosis and lupus anticoagulant . Rev Clin Esp 1996; 196: 24–27 .

14.

McCauliffe DP , Wang L , Satoh M et al. A recombinant 52 kD Ro(SS A) ELISA detects autoantibodies in Sjögren's Syndrome sera that go undetected by conventional serologic assays . J. Rheumatol 1997; 24: 860–886 .

15.

Furukawa F , Kashihara-Sawami M , Lyons MB et al. Binding of antibodies to the extractable nuclear antigens SS-A/Ro and SS-B/La is induced on the surface of human keratinocytes by ultraviolet light: implications for the pathogenesis of photosensitive cutaneous lupus . J Invest Dermatol 1990; 94: 77–85 .

16.

Baboonian C , Venables PJW , Booth J et al. Virus infection induces redistribution and membrane localization of the nuclear antigen La/SS-B: A possible mechanism for autoimmunity . Clin Exp Immunol 1989; 78: 454–459 .

17.

Zhu J . Ultraviolet B irradiation and cytomegalovirus infection synergize to induce the cell surface expression of 52-kD Ro antigen . Clin Exp Immunol 1996; 103: 47–53 .

18.

Dörner T , Hucko M , Mayet WJ et al.. Enhanced membrane expression of the 52kD Ro (SSA) and La (SSB) antigens by human keratinocytes induced by TNF alpha . Ann Rheum Dis 1996; 54: 904–909 .

19.

Alarcon-Segovia D , Ruitz-Arguelles A , Llorente L . Broken dogma: penetration of autoantibodies into living cells . Immunology Today 1996; 17: 163–164 .

20.

McCauliffe DP . Antibody penetration into the cells of mice and men . J Invest Dermatol 1996; 107: 3–4 .