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Measuring disease activity and damage in discoid lupus erythematosus

Lookup NU author(s): Dr Shyamal Wahie, Emerita Professor Elaine McCollORCiD, Professor Nick ReynoldsORCiD, Dr Simon Meggitt, John Cunningham


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P>Background Discoid lupus erythematosus (DLE) is a disfiguring inflammatory skin disease. There is no specific tool for measuring disease severity. Objectives To determine the features needed in a score measuring activity and damage in DLE and to investigate the score's reliability and its correlation with the physician's global assessment of disease severity and the patient-reported Dermatology Quality of Life Index (DLQI). Methods The content of the score was determined following a peer review, pilot work in patients and a preliminary inter-rater reliability study. The Score of Activity and Damage in DLE (SADDLE) measures severity of activity (erythema, scale, induration) and damage (scarring/atrophy and dyspigmentation) attributable to DLE. Summed scores range between 0 and 195. Inter- and intrarater reliability of the score was tested using six assessors and nine patients with DLE. Intraclass correlation coefficients (ICCs) > 0 center dot 7 were considered evidence of good inter- and intrarater agreement. Results The mean +/- SD SADDLE score of nine patients in the inter-rater reliability study was 47 +/- 22 (range 14-102). There was good inter-rater agreement for the total score [ICC 0 center dot 82; 95% confidence interval (CI) 0 center dot 61-0 center dot 95] and for the activity and damage scales, the individual physical signs and the total scores at individual body sites. The total score demonstrated excellent intrarater reliability (ICC 0 center dot 98; 95% CI 0 center dot 86-1 center dot 00). Although there was poor inter-rater agreement for global assessments (ICC 0 center dot 28; 95% CI 0 center dot 06-0 center dot 66), a good correlation was demonstrated between total scores and global assessments (r = 0 center dot 7). A weaker positive correlation was observed between disease activity scores and DLQI (r = 0 center dot 4). Conclusions The SADDLE measures activity and damage in patients with DLE. It demonstrates good inter- and excellent intrarater agreement, over and above that for global assessment. It correlates well with global assessment scores. Further studies are required to investigate SADDLE's responsiveness to change with therapy.

Publication metadata

Author(s): Wahie S, McColl E, Reynolds NJ, Meggitt SJ

Publication type: Article

Publication status: Published

Journal: British Journal of Dermatology

Year: 2010

Volume: 162

Issue: 5

Pages: 1030-1037

Print publication date: 01/03/2010

ISSN (print): 0007-0963

ISSN (electronic): 1365-2133

Publisher: Wiley-Blackwell Publishing Ltd.


DOI: 10.1111/j.1365-2133.2010.09656.x


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