Measuring the activity of the disease in patients with cutaneous lupus erythematosus

Abstract

The Systemic Lupus Activity Measure (SLAM) is a system proposed by rheumatologists to measure disease activity in their patients with systemic lupus erythematosus (LE). It involves scoring a group of clinical symptoms and laboratory findings, the maximum possible score being 84. In systemic LE, the mid-point is between 9 and 12. We applied SLAM to 176 patients with cutaneous LE. Ninety-seven had localized discoid LE (L-DLE), 59 had disseminated discoid LE (D-DLE) and 20 had subacute cutaneous LE (SCLE). Eighty-five patients had low activity disease (0-4 points), 72 mildly active disease (5-9 points), 15 moderately active disease (10-14 points) and only four had very active disease (>/= 15 points). The most frequent lesions in patients who scored more than 10 points were photosensitivity, cicatricial alopecia, Raynaud's phenomenon and oral ulcers. Fifty patients were followed up for more than 5 years (mean follow-up 9 years). Nine of these had an increased SLAM score. Seven had L-DLE, one D-DLE and one SCLE. Seven of the 50 patients had photosensitivity, five cicatricial alopecia, five non-cicatricial alopecia, two Raynaud's phenomenon and two oral ulcers. Three patients who started with L-DLE evolved to D-DLE. The SLAM system is useful in the monitoring of disease activity in patients with cutaneous LE. Over time, even L-DLE patients may develop active disease. Photosensitivity, alopecia, oral ulcers and Raynaud's phenomenon seem to herald a worse prognosis.

Marcadores de envolvimento sistêmico no lúpus eritematoso crônico discóide

“…Entre as manifestações clínicas, fotossensibilidade, alopecia, úlcera oral e fenômeno de Raynaud parecem sugerir pior prognóstico no lúpus cutâneo (16) . Outros estudos clínicos (6,17) sugerem que a sistematização do lúpus eritematoso cutâneo esteja associada com a extensão das lesões cutâneas, com a presença de fenômeno de Raynaud, úlceras orais, fotossensibilidade e positividade de anti-DNA.…”

Disease severity scoring systems in dermatology

“…Konstitütisyonel semptomlar, deri bulguları, göz, retiküloendotelyal sistem, pulmoner, kardiyovasküler, gastrointestinal, nörolojik sistem ve eklem tutulumu hafif, orta, şiddetli olarak skorlanıp toplamı alınır 74 .…”

The CLASI (Cutaneous LE Disease Area and Severity Index): An outcome instrument for cutaneous lupus erythematosus

“…In a recent retrospective study, Parodi et al noted that 60 measures of systemic lupus erythematosus were available, but only three of these appeared useful for dermatologists (Parodi, et al, 2000). Based on their experience with 176 patients with cutaneous LE, Parodi et al found even these scores inadequate for dermatologists and called for revision (Parodi, et al, 2000).…”

“…Based on their experience with 176 patients with cutaneous LE, Parodi et al found even these scores inadequate for dermatologists and called for revision (Parodi, et al, 2000).…”

“…Unfortunately, most of the developed scores are disease-specific. There are some general scores, like the Dermatology Index of Disease Severity (DIDS) (Faust, et al, 1997), but they are too crude in their assessment of body surface area to be useful for diseases like acne or cutaneous lupus erythematosus (CLE), which only affect relatively small areas of the skin (Williams, 1997).In a recent retrospective study, Parodi et al noted that 60 measures of systemic lupus erythematosus were available, but only three of these appeared useful for dermatologists (Parodi, et al, 2000). Based on their experience with 176 patients with cutaneous LE, Parodi et al found even these scores inadequate for dermatologists and called for revision (Parodi, et al, 2000).…”