Assessment of cutaneous disease activity in early lupus and its correlation with quality of life: a cross-sectional study

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease with varied dermatological manifestations that are almost universal. Overall, lupus disease has a major effect on the quality of life in these patients. We assessed the extent of cutaneous disease in early lupus and correlated it with the SLE quality-of-life (SLEQoL) index and disease activity measures. Patients diagnosed as SLE with the skin involved were recruited at the first presentation and were assessed for cutaneous and systemic disease activity using the cutaneous lupus erythematosus disease area and severity index (CLASI) and the Mexican-SLE disease activity index (Mex-SLEDAI), respectively. Quality of life was assessed with the SLEQoL tool while systemic damage was captured by the SLICC damage index. Fifty-two patients with SLE who had cutaneous involvement were enrolled (40, 76.9% females) with a median disease duration of 1 month (1–3.7). The median age was 27.5 years (IQR: 20–41). Median Mex-SLEDAI and SLICC damage index were 8(IQR: 4.5–11) and 0 (0–1), respectively. The median CLASI activity and damage scores were 3 (1–5) and 1 (0–1), respectively. Overall, there was no correlation between SLEQoL with CLASI or CLASI damage. Only the self-image domain of SLEQoL correlated with total CLASI ( ρ = 0.32; p = 0.01) and CLASI-D ( ρ = 0.35; p = 0.02). There was a weak correlation of CLASI with the Mexican-SLEDAI score ( ρ = 0.30; p = 0.03) but not with the SLICC damage index. In this cohort of early lupus, cutaneous disease activity in lupus had a weak correlation with systemic disease. Cutaneous features did not appear to influence the quality of life except in the self-image domain.