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Assessment of cutaneous disease activity in early lupus and its correlation with quality of life: a cross-sectional study

  • Observational Research
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Abstract

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease with varied dermatological manifestations that are almost universal. Overall, lupus disease has a major effect on the quality of life in these patients. We assessed the extent of cutaneous disease in early lupus and correlated it with the SLE quality-of-life (SLEQoL) index and disease activity measures. Patients diagnosed as SLE with the skin involved were recruited at the first presentation and were assessed for cutaneous and systemic disease activity using the cutaneous lupus erythematosus disease area and severity index (CLASI) and the Mexican-SLE disease activity index (Mex-SLEDAI), respectively. Quality of life was assessed with the SLEQoL tool while systemic damage was captured by the SLICC damage index. Fifty-two patients with SLE who had cutaneous involvement were enrolled (40, 76.9% females) with a median disease duration of 1 month (1–3.7). The median age was 27.5 years (IQR: 20–41). Median Mex-SLEDAI and SLICC damage index were 8(IQR: 4.5–11) and 0 (0–1), respectively. The median CLASI activity and damage scores were 3 (1–5) and 1 (0–1), respectively. Overall, there was no correlation between SLEQoL with CLASI or CLASI damage. Only the self-image domain of SLEQoL correlated with total CLASI (ρ = 0.32; p = 0.01) and CLASI-D (ρ = 0.35; p = 0.02). There was a weak correlation of CLASI with the Mexican-SLEDAI score (ρ = 0.30; p = 0.03) but not with the SLICC damage index. In this cohort of early lupus, cutaneous disease activity in lupus had a weak correlation with systemic disease. Cutaneous features did not appear to influence the quality of life except in the self-image domain.

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Data will be available from the corresponding author on reasonable request.

References

  1. Yell JA, Mbuagbaw J, Burge SM (1996) Cutaneous manifestations of systemic lupus erythematosus. Br J Dermatol 135(3):355–362

    Article  CAS  PubMed  Google Scholar 

  2. Stull C, Sprow G, Werth VP (2023) Cutaneous Involvement in Systemic Lupus Erythematosus: A Review for the Rheumatologist. J Rheumatol 50(1):27–35

    Article  CAS  PubMed  Google Scholar 

  3. Kuhn A, Landmann A (2014) The classification and diagnosis of cutaneous lupus erythematosus. J Autoimmun 48–49:14–19

    Article  PubMed  Google Scholar 

  4. Gilliam JN, Sontheimer RD (1981) Distinctive cutaneous subsets in the spectrum of lupus erythematosus. J Am Acad Dermatol 4(4):471–475

    Article  CAS  PubMed  Google Scholar 

  5. Albrecht J, Taylor L, Berlin JA, Dulay S, Ang G, Fakharzadeh S, Kantor J, Kim E, Militello G, McGinnis K, Richardson S, Treat J, Vittorio C, Van Voorhees A, Werth VP (2005) The CLASI (Cutaneous Lupus Erythematosus Disease Area and Severity Index): an outcome instrument for cutaneous lupus erythematosus. J Invest Dermatol 125(5):889–94. https://doi.org/10.1111/j.0022-202X.2005.23889.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kuhn A, Amler S, Beissert S, Böhm M, Brehler R, Ehrchen J et al (2010) Revised cutaneous lupus erythematosus disease area and severity index (RCLASI): a modified outcome instrument for cutaneous lupus erythematosus: revised CLASI for cutaneous lupus erythematosus. Br J Dermatol 163(1):83–92

    Article  CAS  PubMed  Google Scholar 

  7. Klein RS, Morganroth PA, Werth VP (2010) Cutaneous Lupus and the CLASI Instrument. Rheum Dis Clin North Am. 36(1):33–51

    Article  PubMed  PubMed Central  Google Scholar 

  8. Leong KP, Kong KO, Thong BYH, Koh ET, Lian TY, Teh CL et al (2005) Development and preliminary validation of a systemic lupus erythematosus-specific quality-of-life instrument (SLEQOL). Rheumatology 44(10):1267–76

    Article  CAS  PubMed  Google Scholar 

  9. Aziz MM, Galal MAA, Elzohri MH, El-Nouby F, Leong KP (2018) Cross-cultural adaptation and validation of Systemic Lupus Erythematosus Quality of Life questionnaire into Arabic. Lupus 27(5):780–787

    Article  CAS  PubMed  Google Scholar 

  10. Jiang HZ, Lin ZG, Li HJ, Du Q, Tian W, Wang SY et al (2018) The Chinese version of the SLEQOL is a reliable assessment of health-related quality of life in Han Chinese patients with systemic lupus erythematosus. Clin Rheumatol 37(1):151–60

    Article  PubMed  Google Scholar 

  11. Finlay AY, Khan GK (1994) Dermatology Life Quality Index (DLQI)-a simple practical measure for routine clinical use. Clin Exp Dermatol 19(3):210–216

    Article  CAS  PubMed  Google Scholar 

  12. Ware JE, Sherbourne CD (1992) The MOS 36-Item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 30(6):473–83

    Article  PubMed  Google Scholar 

  13. Ferraz LB, Almeida FA, Vasconcellos MR, Faccina AS, Ciconelli RM, Ferraz MB (2006) The impact of lupus erythematosus cutaneous on the Quality of life: the Brazilian-Portuguese version of DLQI. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 15(3):565–570

    Article  CAS  Google Scholar 

  14. Ogunsanya ME, Cho SK, Hudson A, Chong BF (2020) Factors associated with quality of life in cutaneous lupus erythematosus using the Revised Wilson and Cleary Model. Lupus 29(13):1691–1703

    Article  PubMed  PubMed Central  Google Scholar 

  15. Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R et al (2019) 2019 European league against rheumatism/american college of rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheumatol 71(9):1400–1412

    Article  PubMed  PubMed Central  Google Scholar 

  16. Guzmán J, Cardiel MH, Arce-Salinas A, Sánchez-Guerrero J, Alarcón-Segovia D (1992) Measurement of disease activity in systemic lupus erythematosus. Prospective validation of 3 clinical indices. J Rheumatol 19(10):1551–8

    PubMed  Google Scholar 

  17. Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR et al (2012) Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 64(8):2677–2686

    Article  PubMed  PubMed Central  Google Scholar 

  18. Stoll T, Seifert B, Isenberg DA (1996) SLICC/ACR damage index is valid, and renal and pulmonary organ scores are predictors of severe outcome in patients with systemic lupus erythematosus. Rheumatology 35(3):248–254

    Article  CAS  Google Scholar 

  19. Albrecht J, Werth VP (2007) Development of the CLASI as an outcome instrument for cutaneous lupus erythematosus. Dermatol Ther 20(2):93–101

    Article  PubMed  Google Scholar 

  20. Albrecht J, Taylor L, Berlin JA, Dulay S, Ang G, Fakharzadeh S et al (2005) The CLASI (Cutaneous LE Disease Area and Severity Index): an outcome instrument for cutaneous lupus erythematosus. J Invest Dermatol 125(5):889–94

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Chang AY, Ghazi E, Okawa J, Werth VP (2013) Quality of Life Differences Between Responders and Nonresponders in the Treatment of Cutaneous Lupus Erythematosus. JAMA Dermatol 149(1):104

    Article  PubMed  PubMed Central  Google Scholar 

  22. Verma SM, Okawa J, Propert KJ, Werth VP (2014) The impact of skin damage due to cutaneous lupus on quality of life. Br J Dermatol 170(2):315–321

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Vasquez R, Wang D, Tran QP, Adams-Huet B, Chren MM, Costner MI et al (2013) A multicentre, cross-sectional study on quality of life in patients with cutaneous lupus erythematosus: Multicentre, cross-sectional quality of life study of patients with CLE. Br J Dermatol 168(1):145–153

    Article  CAS  PubMed  Google Scholar 

  24. Aggarwal R, Wilke CT, Pickard AS, Vats V, Mikolaitis R, Fogg L et al (2009) Psychometric properties of the euroQol-5D and short form-6D in patients with systemic lupus erythematosus. J Rheumatol 36(6):1209–1216

    Article  PubMed  Google Scholar 

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Funding

No funding was obtained for this study.

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Authors and Affiliations

  1. Department of Dermatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India

    Naga Hinduja, Hemanta Kumar Kar & C. R. Srinivas

  2. Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, India

    Prakashini MV, Debashis Maikap, Prasanta Padhan, Ramnath Misra & Sakir Ahmed

  3. Department of Research and Development, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India

    Sourav Padhee

Authors
  1. Naga Hinduja
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  2. Prakashini MV
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  3. Sourav Padhee
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  4. Debashis Maikap
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  5. Prasanta Padhan
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  6. Hemanta Kumar Kar
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  7. Ramnath Misra
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  8. C. R. Srinivas
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  9. Sakir Ahmed
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Contributions

The study concept and framework were devised by SA, SCR and HKK. All authors contributed substantially for data acquisition. Data analysis was done by SP. PMV, NG and SA drafted the manuscript, and all authors were involved in the critical revision for intellectual content. All authors take equal responsibility for the data published and the authenticity of the research.

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Correspondence to Sakir Ahmed.

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Hinduja, N., MV, P., Padhee, S. et al. Assessment of cutaneous disease activity in early lupus and its correlation with quality of life: a cross-sectional study. Rheumatol Int 43, 1835–1840 (2023). https://doi.org/10.1007/s00296-023-05353-y

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  • DOI: https://doi.org/10.1007/s00296-023-05353-y

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