Natural history of disease activity and damage in patients with cutaneous lupus erythematosus

Khor Jia Ker, Noelle M. Teske, Rui Feng, Benjamin F. Chong, Victoria P. Werth

Research output: Contribution to journalArticle

Abstract

Background: Long-term studies characterizing disease course of cutaneous lupus erythematosus (CLE) patients on standard-of-care treatments are lacking. Objective: We characterized and compared disease course of CLE patients using Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Methods: In total, 83 CLE patients with CLASI scores collected from ≥3 study visits within 2 years had disease activity and damage trends calculated by average change scores (ACS). Trends were classified as improved (ACS ≤−3), worsened (ACS ≥3), or stable (–3 < ACS < 3). Linear regression models compared CLASI trends between groups. Results: Most patients (72.73%) with initial CLASI activity (CLASI-A) scores >9 (N = 33) had improved disease activity versus 14.00% of those with initial CLASI-A scores ≤9 (N = 50). Linear regression analyses showed significant improvement in CLASI-A scores in patients of minority races (P < .05), with baseline CLASI-A scores >9 (P < .0001), baseline CLASI damage (CLASI-D) scores ≥10 (P = .0001), and CLE disease duration ≤1 year (P = .01). Of 28 patients with baseline CLASI-D scores ≥10, 35.71% had improvements in damage, while 5.26% of patients with initial CLASI-D scores of 5-9 (N = 19) and 0% with initial CLASI-D scores <5 (N = 36) (P = .0005) had improvements. Limitations: Limitations include small sample size. Conclusion: Baseline CLASI-A score >9, minority race, and short disease duration predict CLE disease activity improvement. A baseline CLASI-D score ≥10 is associated with disease damage improvement.

Original languageEnglish (US)
JournalJournal of the American Academy of Dermatology
DOIs
StateAccepted/In press - Jan 1 2018

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Cutaneous Lupus Erythematosus
Standard of Care

Keywords

  • Cutaneous Lupus Disease Area and Severity Index
  • cutaneous lupus erythematosus
  • disease activity
  • disease damage
  • longitudinal

ASJC Scopus subject areas

  • Dermatology

Cite this

Natural history of disease activity and damage in patients with cutaneous lupus erythematosus. / Ker, Khor Jia; Teske, Noelle M.; Feng, Rui; Chong, Benjamin F.; Werth, Victoria P.

In: Journal of the American Academy of Dermatology, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Natural history of disease activity and damage in patients with cutaneous lupus erythematosus",
abstract = "Background: Long-term studies characterizing disease course of cutaneous lupus erythematosus (CLE) patients on standard-of-care treatments are lacking. Objective: We characterized and compared disease course of CLE patients using Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Methods: In total, 83 CLE patients with CLASI scores collected from ≥3 study visits within 2 years had disease activity and damage trends calculated by average change scores (ACS). Trends were classified as improved (ACS ≤−3), worsened (ACS ≥3), or stable (–3 < ACS < 3). Linear regression models compared CLASI trends between groups. Results: Most patients (72.73{\%}) with initial CLASI activity (CLASI-A) scores >9 (N = 33) had improved disease activity versus 14.00{\%} of those with initial CLASI-A scores ≤9 (N = 50). Linear regression analyses showed significant improvement in CLASI-A scores in patients of minority races (P < .05), with baseline CLASI-A scores >9 (P < .0001), baseline CLASI damage (CLASI-D) scores ≥10 (P = .0001), and CLE disease duration ≤1 year (P = .01). Of 28 patients with baseline CLASI-D scores ≥10, 35.71{\%} had improvements in damage, while 5.26{\%} of patients with initial CLASI-D scores of 5-9 (N = 19) and 0{\%} with initial CLASI-D scores <5 (N = 36) (P = .0005) had improvements. Limitations: Limitations include small sample size. Conclusion: Baseline CLASI-A score >9, minority race, and short disease duration predict CLE disease activity improvement. A baseline CLASI-D score ≥10 is associated with disease damage improvement.",
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AB - Background: Long-term studies characterizing disease course of cutaneous lupus erythematosus (CLE) patients on standard-of-care treatments are lacking. Objective: We characterized and compared disease course of CLE patients using Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Methods: In total, 83 CLE patients with CLASI scores collected from ≥3 study visits within 2 years had disease activity and damage trends calculated by average change scores (ACS). Trends were classified as improved (ACS ≤−3), worsened (ACS ≥3), or stable (–3 < ACS < 3). Linear regression models compared CLASI trends between groups. Results: Most patients (72.73%) with initial CLASI activity (CLASI-A) scores >9 (N = 33) had improved disease activity versus 14.00% of those with initial CLASI-A scores ≤9 (N = 50). Linear regression analyses showed significant improvement in CLASI-A scores in patients of minority races (P < .05), with baseline CLASI-A scores >9 (P < .0001), baseline CLASI damage (CLASI-D) scores ≥10 (P = .0001), and CLE disease duration ≤1 year (P = .01). Of 28 patients with baseline CLASI-D scores ≥10, 35.71% had improvements in damage, while 5.26% of patients with initial CLASI-D scores of 5-9 (N = 19) and 0% with initial CLASI-D scores <5 (N = 36) (P = .0005) had improvements. Limitations: Limitations include small sample size. Conclusion: Baseline CLASI-A score >9, minority race, and short disease duration predict CLE disease activity improvement. A baseline CLASI-D score ≥10 is associated with disease damage improvement.

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