Cross-sectional characteristics of pediatric-onset discoid lupus erythematosus: Results of a multicenter, retrospective cohort study.

BACKGROUND: The incidence of systemic lupus in children with discoid lupus is unknown. OBJECTIVE: This study assessed the baseline characteristics of patients with pediatric discoid lupus erythematosus (pDLE). METHODS: Medical records at 17 sites were reviewed for pediatric dermatology and rheumatology patients with discoid lupus erythematosus. The inclusion criteria were clinical and/or histopathologic diagnosis of discoid lupus erythematosus with an age at onset of <18 years. Baseline data were collected at the first documented visit. Outcomes included diagnosis of systemic lupus erythematosus (SLE) at the baseline visit using the 1997 American College of Rheumatology (primary) and the 2012 Systemic Lupus International Collaborating Clinics (secondary) criteria. RESULTS: Of the >1500 charts reviewed, 438 patients met the inclusion criteria. The cohort was predominantly female (72%) and racially/ethnically diverse. A diagnosis of SLE at the baseline visit (pDLE + SLE) was rendered in 162 (37%) patients using the American College of Rheumatology and in 181 (41%) patients using the Systemic Lupus International Collaborating Clinics criteria. Patients with pDLE + SLE were older at the time of rash onset (median, 12.9 vs 8.9 years; P < .001), with shorter time from discoid lupus erythematosus onset to diagnosis, compared with patients with pDLE-only (median, 2 vs 7 months; P < .001). Patients with pDLE + SLE were more likely to be female (P = .004), with generalized discoid lupus erythematosus and clinically aggressive disease, including end-organ involvement, positive serologies, and higher- titer levels of antinuclear antibodies (P < .001). LIMITATIONS: Retrospective study. CONCLUSION: A diagnosis of discoid lupus erythematosus in adolescence should prompt thorough screening for SLE.

The unheralded value of arthroscopy using local anesthesia for diagnostic specificity and intraoperative corroboration of therapeutic achievement.

The senior author has performed more than 600 "therapeutic" arthroscopies under local anesthesia since 1978. The authors believe that the cases presented illustrate the increased diagnostic accuracy offered by performing arthroscopy of the knee under local anesthetic in certain types of cases. We are by no means advocating that all arthroscopies of the knee be performed under local anesthesia. Certainly, the majority of knee arthroscopies need not be performed under local anesthesia, because the diagnosis is usually evident. Perhaps when the diagnosis is not clear, a combination of local with regional or with general would be best, with performance of the diagnostic portion of the arthroscopy under local anesthesia. When an instantaneous improvement is possible, such as change in joint motion, or when some change in joint dynamics may be visualized, local should then be continued through the therapeutic conclusion of the procedure. Arthroscopy under local anesthesia has also been performed by the authors on the shoulder, elbow, and ankle, where the diagnostic benefits have been realized. Certain reconstructive operations, such as patellar realignments, are worthy of performance under local anesthesia in selected cases. In conclusion, the authors believe that arthroscopy of the knee and other joints under local anesthesia may add measurably to the diagnostic capability of the arthroscopist, and not infrequently to a therapeutic advantage.