title: Development of the CLASI as a tool to measure disease severity and responsiveness to therapy in cutaneous lupus erythematosus.
abstract: OBJECTIVE
  To determine how to use the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) to classify patients according to disease severity (mild, moderate, and severe) and to identify which patients respond to therapy.
  
  
  METHODS
  Cohort.
  
  
  METHODS
  The connective-tissue disease clinic at the Hospital of the University of Pennsylvania, Philadelphia.
  
  
  METHODS
  Seventy-five patients with clinical or histopathologic evidence of cutaneous lupus erythematosus or systemic lupus erythematosus were included in the study.
  
  
  METHODS
  The CLASI, Skindex-29, and the physician's subjective assessment of severity and improvement were completed at every visit.
  
  
  RESULTS
  Disease severity was assessed with 45 patient visits. Mild, moderate, and severe disease corresponded with CLASI activity score ranges of 0 to 9, 10 to 20, and 21 to 70, respectively. Improvement in disease activity was assessed in 74 patients. A clinical improvement was associated with a mean 3-point or 18% decrease in the CLASI activity score. However, receiver operating characteristic analysis demonstrated an increased percentage of patients correctly classified when a 4-point (sensitivity, 39%; specificity, 93%; correctly classified, 76%) or 20% (sensitivity, 46%; specificity, 78%; correctly classified, 67%) decrease in the CLASI activity score was used instead to identify improvement.
  
  
  CONCLUSIONS
  The CLASI can be used to classify patients into groups according to disease severity and to identify clinically significant improvements in disease activity.
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. werth@mail.med.upenn.edu
authors.forename: Rachel
authors.initials: R
authors.lastname: Klein
authors.forename: Siamak
authors.initials: S
authors.lastname: Moghadam-Kia
authors.forename: Jonathan
authors.initials: J
authors.lastname: LoMonico
authors.forename: Joyce
authors.initials: J
authors.lastname: Okawa
authors.forename: Chris
authors.initials: C
authors.lastname: Coley
authors.forename: Lynne
authors.initials: L
authors.lastname: Taylor
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Troxel
authors.forename: Victoria P
authors.initials: VP
authors.lastname: Werth
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D008178:Lupus Erythematosus, Cutaneous / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome