title: Revised Cutaneous Lupus Erythematosus Disease Area and Severity Index (RCLASI): a modified outcome instrument for cutaneous lupus erythematosus.
abstract: BACKGROUND
  In 2005, a scoring system (CLASI, Cutaneous Lupus Erythematosus Disease Area and Severity Index) was developed for patients with cutaneous lupus erythematosus (CLE) to assess disease 'activity' and 'damage'. However, the CLASI does not give an accurate assessment of the severity in all disease subtypes.
  
  
  OBJECTIVE
  The main objective of this study was to analyse critically the included parameters of the CLASI and to revise the activity and damage score taking into account various clinical features of the different subtypes of CLE. The revised CLASI (RCLASI) was also validated for use in clinical trials. Patients and methods A RCLASI was designed with regard to the anatomical region (i.e. face, chest, arms) and morphological aspects (i.e. erythema, scaling/hyperkeratosis, oedema/infiltration, scarring/atrophy) of skin lesions and evaluated by nine dermatologists who scored 12 patients with different subtypes of CLE to estimate inter- and intrarater reliability.
  
  
  RESULTS
  Reliability studies demonstrated an intraclass correlation coefficient (ICC) for an inter-rater reliability of 0.89 for the activity score [95% confidence interval (CI) 0.79-0.96] and of 0.79 for the damage score (95% CI 0.62-0.92). The ICC for intrarater reliability for the activity score was 0.92 (95% CI 0.89-0.95) and the ICC for the damage score was 0.95 (95% CI 0.92-0.98).
  
  
  CONCLUSIONS
  In the present study, a RCLASI was developed by experts, and reliability studies supported the validity and applicability of the revised scoring instrument for CLE. Thus, the RCLASI is a valuable instrument in multicentre studies and for the clinical evaluation of activity and damage in different disease subtypes.
authors.affiliation: Department of Dermatology, University of Münster, Von-Esmarch-Strasse 58, D-48149 Münster, Germany. kuhnan@uni-muenster.de
authors.forename: A
authors.initials: A
authors.lastname: Kuhn
authors.forename: A M
authors.initials: AM
authors.lastname: Meuth
authors.forename: D
authors.initials: D
authors.lastname: Bein
authors.forename: S
authors.initials: S
authors.lastname: Amler
authors.forename: S
authors.initials: S
authors.lastname: Beissert
authors.forename: M
authors.initials: M
authors.lastname: Böhm
authors.forename: R
authors.initials: R
authors.lastname: Brehler
authors.forename: J
authors.initials: J
authors.lastname: Ehrchen
authors.forename: S
authors.initials: S
authors.lastname: Grundmann
authors.forename: M
authors.initials: M
authors.lastname: Haust
authors.forename: V
authors.initials: V
authors.lastname: Ruland
authors.forename: M
authors.initials: M
authors.lastname: Schiller
authors.forename: P
authors.initials: P
authors.lastname: Schulz
authors.forename: S
authors.initials: S
authors.lastname: Ständer
authors.forename: C
authors.initials: C
authors.lastname: Sauerland
authors.forename: W
authors.initials: W
authors.lastname: Köpcke
authors.forename: T A
authors.initials: TA
authors.lastname: Luger
authors.forename: G
authors.initials: G
authors.lastname: Bonsmann
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008178:Lupus Erythematosus, Cutaneous / Q000145:classification* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D055815:Young Adult