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Dermatoglyphic study of systemic lupus erythematosus.

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83
DERMATOGLYPHIC STUDY OF
SYSTEMIC LUPUS ERYTHEMATOSUS
ROBERT W. DUBOIS, JOHN M. WEINER, and EDMUND L. DUBOIS
Dermatogl yphic patterns were analyzed from two
races of patients with SLE: a Mexican-American series of
27 females with SLE and 28 matched controls, and a
Caucasian series of 28 females with SLE and 26 matched
controls. Eighty-five measurements and 23 indices were
analyzed. From these data, eleven parameters were statistically significant, four separating the Mexican-American
SLE group from their controls and seven separating the
Caucasian SLE group from their controls (P values <
0.002 to < 0.05). Only two parameters were significantly
different between the two normal series, but nine parameters differentiated the Mexican-American SLE from the
Caucasian SLE groups. A multiple linear discriminant
function was computed using the most significant parameters. A misclassification rate of 25-30% was obFrom the Section of Clinical Immunology and Rheumatic
Disease, Department of Medicine, University of Southern California
School of Medicine, Los Angeles, California.
Supported by USPH Grant AM-15755.
Robert W. Dubois: Student Fellow in Rheumatology, Section of Clinical Immunology and Rheumatic Disease, Department of
Medicine, University of Southern California School of Medicine; John
M. Weiner. Dr.P.H.: Associate Professor of Medicine and Chief,
Clinical Research Information Systems Unit, Department of Medicine,
University of Southern California School of Medicine; Edmund L.
Dubois, M.D.: Clinical Professor of Medicine, Section of Clinical
Immunology and Rheumatic Disease, Department of Medicine, University of Southern California School of Medicine.
Address reprint requests t o Edmund L. Dubois. M.D., Department of Medicine, University of Southern California School of
Medicine, 2025 Zonal Avenue, Los Angeles, California 90033.
Submitted for publication March 27, 1975; accepted June 30,
1975.
Arthritis and Rheumatism, Vol. 19, No. 1 (January-February 1976)
served between patients and matched controls. Dermatoglyphic patterns have been shown to be genetically
controlled. These data suggest a genetic abnormality
associated with SLE.
Dermatoglyphics, as defined by Cummins and
Midlo, is the study of ridged skin that appears on the
fingers, toes, palms, and soles (1 ). Although the exact
methodology of fingerprint pattern inheritance is unknown, it has been shown to be genetically controlled in
sibling studies and in chromosomal abnormalities (2).
Rose et a1 in 1972 reported dermatoglyphic differences
in women with increased fetal wastage (3). These findings stimulated research in women with SLE, because in
this disease it has been shown that the incidence of
spontaneous abortions is higher than in a control group
(4).Three studies to date have investigated the dermatoglyphic patterns of patients with SLE. Dubes, Fraga,
and Qazi all observed statistically significant findings
between SLE and matched control populations (5-7).
However in each of the three studies the significant features were different. These conflicting findings stimulated this current study which uses a larger population
and covers more parameters than the previous work, in
order to determine if any significant difference exists.
MATERIALS AND METHODS
Finger and palm prints were obtained from two groups
of SLE patients and compared with two sets of age-, race-, and
sex-matched controls. The patients fulfilled the preliminary
DUBOIS ET A L
84
IGIT RIDGE COUNT,
FI NGER LENG
a-b RIDGE
COUNT.
PALMAR PATTERNS
t-a DISTANCE
ULNARWRIST CREASE
(WC)
t - TRlRADUlS
LATERAL DISPLACEMENT
Fig I . Dertnatoglyphic structure.
A R A criteria for the diagnosis of SLE (8). One group consisted of 27 Mexican-American females (characterized by
Spanish surnames and racial characteristics) with SLE who
were compared with 28 controls and the other group was 28
Caucasian females with SLE compared with 26 controls. The
normal females had no past or family history of rheumatic
disease and were either attending obstetric clinics or volunteers. The authors used the FaurotB process of inkless prints
on sensitized paper for recording the dermatoglyphic patterns
(Faurot, Inc, New York, New York). Becauseof Rose's observation on fetal wastage (3), the subjects were questioned concerning the number of spontaneous abortions and successful
pregnancies.
The following measurements and data were compiled:
finger patterns and ridge counts on all 10 fingers, palmar patterns in the hypothenar, thenar first, second, third, and fourth
interdigital areas, a-b ridge counts, axial t-triradii placement,
finger length, and atd angles (Figure I ) . The axial t-triradius
vertical placement was measured by dropping a perpendicular
line from the t-triradius to a line approximating the wrist
crease. Its lateral displacement was determined by the distances between the t-triradius and perpendicular lines dropped
from the base of the index finger and the ulnar edge of the
hand to the wrist crease.
Measurements were rechecked blind and all statistically significant features were remeasured independently by
two observers.
The data obtained were statistically analyzed using
Student's t and chi-square test where applicable. Later the
most significant parameters were analyzed using multiple
linear discriminant analysis (9).
RESULTS
Eleven features proved significant out of the 85
original measurements and 23 calculated indices examined in either the Mexican-American female or the Caucasian female groups. In separating t h e Mexican-American normals from the SLEs, four parameters were
statistically significant (Figure 2). T h e radial measurement of the axial t-triradius in the right hand of the
Mexican-American S L E group was decreased when
compared with the control ( P < 0.0027). The composite
measurement of the right axial t-triradius (radial measurement/ulnar measurement) also showed a significant
difference ( P < 0.0036). Both these results indicate a
radial shift of the t-triradius in S L E patients. In the left
hypothenar area, more patterns appeared in the Mexican-American S L E group ( P < 0.036). In the left-hand
first digit (thumb) in this group, more whorls were observed than in the control group where more loops were
observed ( P < 0.002).
In the Caucasian SLE group, seven significant
parameters were observed (Figure 3). In the left hand of
the SLE group, both the ulnar displacement of the left
axial t-triradius ( P < 0.0026) and the composite mea-
DERMATOGLYPHIC STUDY OF SLE
85
pattern in the left hypothenar area, and vertical displacement of the right axial t-triradius (Table 2). The
misclassification rate was 26% for the 54 in this group ( P
< 0.0012).
DISCUSSION
LEFT
RIGHT
t-TRIR ADllJS
SPLACED RADIALLY
\WRIST
The three previous investigations of dermatoglyphics and SLE showed different significant features.
Dubes observed a displacement of the axial t-triradius
(5). Fraga and Qazi found changes in the pattern frequencies of the fingers (6, 7). Definite racial differences
have previously been shown in dermatoglyphic patterns (10, 11). Therefore, because Fraga observed Mexicans, Dubes observed Caucasians, and Qazi observed
blacks, their data should be different. The authors of
this paper analyzed both Mexican-Americans and Caucasians, and the results in the Caucasian SLE group
agree with those of Dubes. He observed an ulnar displacement of the right axial t-triradius, and the present
data concur ( P < 0.05). Dubes also found an ulnar
displacement of the same measurement predominantly
CREASE
Fig 2. Signijicant parameters in Mexican-A merican groups.
surement
(radial displacement/ulnar displacement,
P < 0.01 1 ) of the left axial t-triradius were significant,
indicating an ulnar shift of the triradius in this group.
I n this same hand the SLE group showed a decrease in
the log of the a-b ridge count ( P < 0.05) and an increase
in hypothenar patterns ( P < 0.036). In the right hand of
the SLE group, the authors observed a decrease in the
atd angle ( P < 0.042), a decrease in the log of the a-b
distance ( P < 0.05), and a proximal displacement of the
axial t-triradius ( P < 0.05).
The observed number of habitual aborters with
SLE was insufficient for analysis.
Discriminant analysis was performed using data
for each race. In the Mexican-American SLE group the
radial measurement of the right axial t-triradius and the
presence of a pattern in the left hypothenar area were
the only significant parameters in the discriminant function ( P < 0.0028) (Table I ) . The misclassification rate
for the 54 in this group was 28%. There were insufficient
data to make these measurements in one case in the
normal group. In the Caucasian SLE group three parameters were used in the discriminant function: the ulnar
measurement of the left axial t-triradius, presence of a
RlST CREASE
LEFT
RIGHT
RIDGE COUNT LESS
DISPLACEMENT LE
SLE
atd
ANGLE LES
DISPLACED ULNAD
PROXIMALLY DISPLACED’
Fig 3. Significant parameters in Caucasian groups.
DUBOIS ET AL
86
Table 1. Discriminant Analysis of Mexican-Americans Using
Two Param ters
1 ) Radial displacement of right axial t-triradius
2) Presence of a pattern in the left hypothenar area
~
Dermatographically
Analyzed as:
~~
Diagnosed
Normal
Diagnosed
SLE
Totdl
20
1
n
28
19
26
21
54
~~~
Normal
SLE
TOTAL
P
21 *
< 0.0028
Misclassification rate: 28%.
* Insufficient data in one case.
in the right hand. In the present series the ulnar shift of
this same measurement was statistically more significant
in the left hand. However several of Dubes’ other less
statistically significant findings were not confirmed in
the present study. The discrepancy could be due to sampling error, because his Caucasian SLE group consisted
of only 7 females.
This study did not deal with black SLE patients.
No correlation can be drawn.
In the Mexican SLE patients Fragaetal observed
a diminution of radial loops and digital arches ( 6 ) . In
t h e present series a significant increase in whorls (P <
0.002) was found only in the left-hand first finger. Fraga
also observed more patterns i n the thenar first interdigital region and the axial t-triradius in t’. The data of
the present authors do not substantiate either of these
findings. Possibly, Fraga’s Mexican population differed
from the Mexican-American group in the Southern California area.
Dermatoglyphic differences are known to exist
between races (10, 11). In this investigation two features
were observed to be statistically significant in separating
the two normal groups: the ridge density on the left
thumb ( P < 0.046) and the a-b ridge density on the left
hand (P < 0.003). The same approximate result was
expected between the Mexican-American SLE group
and the Caucasian SLE group. In fact nine significant
parameters differentiated the two SLE groups, including
the two stated above. These other features included: atd
angle right hand (P < 0.014), radial ( P < 0.0033) and
ulnar (P < 0.00091) measur,ement of the right axial ttriradius, ulnar measurement of the left axial t-triradius
( P < 0.0022), pattern types on the right fingers (P <
0.05),and the axial t-triradius lateral displacement (composite measurement) in both the right (P< 0.00021) and
left (P < 0.013) hands.
The discriminant analysis showed a misclassification rate of 25-30%. Although dermatoglyphic
changes were associated with SLE, the measurements
used were not sufficiently different to suggest their use in
the earlier detection of SLE patients.
Several genetically inherited diseases show abnormalities in dermatoglyphics. Differences have been observed in the palm prints of patients with Down’s syndrome and those with Klinefelter’s syndrome when they
were compared with matched controls (12). Furthermore finger and palm prints have been shown to be
genetically controlled (2). Viral infections such as congenital rubella may also modify dermatoglyphic patterns (1 3, 14). Therefore the finding of statistically significant differences between the SLE and normal groups
suggests either a genetic abnormality or alteration by a
congenitally transmitted virus or perhaps both as a
cause of these changes.
REFERENCES
1 . Cummins H, Midlo C: Palmar and plantar epidermal
2.
3.
Table 2 . Discriminant Analysis of Caucasians Using Three Parameters
I ) Ulnar displacement of left axial t-triradiur
2 ) Presence of a pattern in the left hypothenar area
3 ) Vertical displacement of right axial t-triradius
Dermatographically
Analyzed as:
Diagnosed
Normal
Diagnosed
SLE
Total
Normal
SLE
19
7
21
26
28
28
54
1
TOTAL
P
<
Misclassification rate: 26%.
26
0.0012
4.
5.
6.
7.
ridge configurations (dermatoglyphics) in EuropeanAmericans. Am J Phys Anthropol 9:471, 1926
Holt SB: The Genetics of Dermal Ridges. Charles C.
Thomas, Springfield, Illinois, 1968
Rose LI, Gabbe SG, Teichholz LE, et al: Dermatoglyphics
associated with fetal wastage. N Engl J Med 287:451-452,
1972
Lupus Erythematosus. A Review of the Current Status of
Discoid and Systemic Lupus Erythematosus and Their
Variants. Second edition. Edited by EL Dubois. Los Angeles, University of Southern California Press, 1974
Dubes RC, Rupe CE: A pattern recognition study of dermatoglyphic traits. Proc San Diego Biomed Symp 13, 1974
Fraga A, Armendares S, Mintz G , et al: Dermatoglyphic
patterns in systemic lupus erythematosus (SLE) and their
changes in patients with increased fetal wastage. J
Rheumatol 1:35, 1974 (suppl)
Qazi Q H , Fikrig SM, Smithwick EM, et al: Dermato-
DERMATOGLYPHIC STUDY OF SLE
glyphics and systemic lupus erythematosus (SLE) Pediatr
Res 8:394, 1974
8. Cohen AS, Reynolds WE, Franklin EC, et al: Preliminary
criteria for the classification of systemic lupus erythematosus. Bull Rheum Dis 21:643-648, 1971
9. Weiner J M , Marmorston J: Statistical techniques of difference. Ann N Y Acad Sci 161:641-667, 1969
10. Zavala C, Cob0 A, Lisker R: Dermatoglyphic patterns in
Mexican Indian groups. Hum Hered 21:394401, 1971
I 1. Maricq HR: “Ethnic” differences in the fingerprint data in
87
an “all white” control sample. Hum Hered 22573-577,
1972
12. Alter M: Dermatoglyphic analysis as a diagnostic tool.
Medicine 46:35-56, 1966
13. Achs R, Harper RG, Siege1 M: Unusual dermatoglyphic
findings associated with rubella embryopathy. N Engl J
Med 274:148-150, 1966
14. Alter M, Schulenberg R: Dermatoglyphics in the rubella
syndrome. JAMA 197:685-688, 1966
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