Applicability of the Cutaneous Lupus Erythematous disease Area and Severity Index (CLASI) in patients with Systemic Lupus Erythematosus (SLE)

Pankaj Sharad, Salphale (2009) Applicability of the Cutaneous Lupus Erythematous disease Area and Severity Index (CLASI) in patients with Systemic Lupus Erythematosus (SLE). Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : Systemic lupus erythematosus (SLE) is a multisystem, autoimmune connective tissue disorder with a wide range of clinical features. Dermatological manifestations are among the most frequent presenting signs and remain a major source of disease flares throughout the course of the illness. Assessment of activity of and damage caused by cutaneous disease is essential from research as well as practice point of view. Most of the indices for systemic activity assessment include cutaneous manifestations as one of the components. In 2005, an exclusive index for the cutaneous disease named CLASI (Cutaneous lupus area and severity index) was formulated and applied to research. CLASI assesses the activity of and damage caused by cutaneous lupus erythematosus and has so far been applied to only LE specific lesions. Any given LE patient may manifest more than one type of LE-specific skin lesion, but, in most patients one form of LEspecific skin involvement predominates. The uniqueness of CLASI lies in its ability to separate damage and activity as such a distinction is essential in any disease that can cause severe persistent organ damage. Systemic activity of lupus can be assessed by numerous indices of which SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) is the simplest tool to use . It grades the activity of the disease from “no activity” to “very high activity”. Patients with LE-nonspecific skin manifestations have significantly increased disease activity compared to those with only LE-specific lesions.5 AIMS & OBJECTIVES : 1. To study the applicability of Cutaneous Lupus Erythematosus Disease Area and Severity index (CLASI) in specific lesions of cutaneous lupus erythematosus occurring in SLE patients in our population. 2. To assess the disease activity of patients with Systemic Lupus Erythematosus (SLE) and skin lesions using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). 3. To correlate SLEDAI with CLASI activity score in SLE patients with Lupus Erythematosus (LE) specific skin lesions. PATIENTS AND METHODS : The study was conducted from 1st May 2007 to 30th August 2008 (16 months). It was a prospective, cross sectional study done in the Department of Dermatology, Venereology and Leprosy. The subjects were those attending the outpatient department and inpatients referred to us from the Medical, Pediatrics and rheumatology units. Inclusion Criteria: 1. All patients with systemic lupus erythematosus having lupus specific and nonspecific lesions. Exclusion Criteria: 1. Patients without a cutaneous manifestation of LE. 2. Patients not willing to be included. 3. Neonatal lupus. Ninety-three patients with a diagnosis of SLE according to the 1997 modification of ARA criteria 14 (Appendix D) were included in the study. Three patients were excluded as they were subsequently diagnosed to have mixed connective tissue disease. Patients were examined by the principal investigator. A detailed proforma was filled (Appendix E). The demographic data included age, address, gender and occupation. The presenting mucocutaneous complaints and their respective durations were noted. The body sites affected by lupus specific and non-specific manifestations were recorded. A history of drug intake (corticosteroids, immunosuppressants and hydroxychloroquine) and the topical applications used by the patient in the three months prior to their presentation was noted. Subjects were informed about the purpose of the study (Appendix F) and informed consent (Appendix G) was obtained. Separate child and adolescent assent forms (Appendices H1 & H2) were used for patients in the age groups of 7- 12 years and 13-17 years respectively. Clinical photographs of lesions were taken after patient consent or parenteral consent in case of children. RESULTS : Ninety three patients met the inclusion criteria of the study. Three patients were excluded as they were subsequently diagnosed to have mixed connective tissue disease. The majority of patients were from West Bengal (40.9%), the southern states of Tamilnadu, Andhra Pradesh and Kerala (29%) and Jharkhand (10.75%). The remaining patients (19.3%) were mostly from the North Eastern and other Indian states and Bangladesh. There were 87 adults (>15 years) and 6 children (≤ 15 years). The mean age of the patients was 29.8±12.73 years (range 5-65). There were 87 females and 6 males. The mean age of males was 28.5±10.46 years (range 13-40) and that of females was 29.9 ±10.46 years (range 5 -65). The male to female ratio was 1:14.5 and 1:5 among adults and children respectively. The most common presenting complaint was alopecia (67 patients; 72%) followed by photosensitivity (64 patients; 68%) and oral ulcers (57 patients; 61%). Skin lesions were the first manifestation in 31 patients (33.3%). The most common site for skin lesions was the face (85%) followed by involvement of the trunk (75%) and the upper limbs (70%). The mean duration of SLE at presentation was 31.9 months (range 2-228 months; SD 42.11) and the mean duration of skin lesions was 12 months (range 0.25 -84 months; SD 16.20) CONCLUSIONS : 1. This study has shown that CLASI is an effective tool to assess cutaneous activity and damage of specific lesions of LE. The mean CLASI activity score was 15.6 (range 2 to 39) and the mean damage score was 8.24 (range 1 to 30). The scores seen in our patients were comparable to other studies. 2. The mean CLASI activity scores were higher in those who had higher number of anatomical sites affected and those with SCLE, and ACLE occurring in combination with other specific lesions. 3. The CLASI damage scores correlated with the duration of SLE (p<0.01) and also with the duration of skin lesions (p<0.01). 4. The correlation of CLASI activity score and the SLEDAI score was poor (p=0.16). 5. The mean SLEDAI scores of patients with non-specific lesions were higher than those with specific lesions.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Applicability ; Cutaneous Lupus Erythematous disease Area and Severity Index (CLASI) ; patients ; Systemic Lupus Erythematosus (SLE).
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 02 Mar 2018 16:19
Last Modified: 03 Mar 2018 05:57

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