Prognostic Value of Livedo Reticularis and Raynaud’s Phenomenon in Systemic Lupus Erythematosus Patients

Abstract Background: Systemic lupus erythematosus is a chronic multisystem autoimmune inflammatory disease. Skin is con-sidered as the second most commonly affected organ in lupus patients. Livedo reticularis and Raynaud’s phenomenon are considered as cutaneous vascular manifestations of nonspecific skin changes that occur in systemic lupus erythematosus. Aim of Study: This study aims to examine the frequency of Raynaud’s phenomenon and livedo reticularis in SLE patients and its relation to disease outcomes. Patients and Methods: This study is a post hoc analysis of previous study titled (Disease characteristics in patients with juvenile- and adult-onset systemic lupus erythematosus) con-ducted in Kasr Al-Aini Medical Hospital from October 2023 to April 2024. In the current study we retrospectively analyzed medical records of a total of 422 SLE patients, according to presence or absence of livedo reticularis and Raynaud’s phe-nomenonpatients were divided in groups, and comparative studies between groups were conducted regarding demograph-ic, clinical, and laboratory parameters. Furthermore, groups were compared regarding SLE Disease Activity Index (SLE-DAI), and the Systemic Lupus International Collaborating Clinics/American College Rheumatology Damage Index scores (SLICC). Results: The mean of disease duration was 9.7±6.7. Livedo reticularis and Raynaud’s were more frequent in juvenile on-set lupus patients (p=0.043, p=0.002). Livedo reticularis and Raynaud’s patients showed statistically significant higher fre-quency of thrombosis (p<0.001, p=0.004), secondary vasculi-tis (p=0.017, p<0.001), digital gangrene (p<0.001, p=0.003), more frequent APL Antibodies (p=0.013, p=0.005) and high-er damage index (p<0.001, p=0.031). Livedo patients showed statistically significant higher frequency of neuropsychiatric manifestations (NP), musculoskeletal manifestations, Hypo-complementemia (p<0.001, p=0.036, p=0.039), and higher fre-quency of dyslipidemia and renal failure (p=0.011, p=0.040), while Raynaud’s patients showed higher frequency of avascular necrosis (p=0.001). On comparing Patients with livedo and/or Raynaud’s to those without, patients with livedo and or raynaud’s showed statistically significant higher SLICC damage index (p=0.018), secondary vasculitis (p<0.001), NP (p=0.036), thrombosis (p=0.002), and more frequent APL antibodies (p=0.003). Conclusion: Lupus patients with Raynaud’s and/or livedo reticularis may be associated worse disease outcomes and high-er damage index.