Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in paediatric cutaneous lupus among paediatric dermatologists and rheumatologists

C. J. Kushner; M. Tarazi; R. G. Gaffney; R. Feng; K. Ardalan; H. A. Brandling-Bennett; L. Castelo-Soccio; J. C. Chang; Y. E. Chiu; S. Gmuca; R. D. Hunt; P. J. Kahn; A. M. Knight; J. Mehta; D. R. Pearson; J. R. Treat; J. Wan; A. C. Yeguez; J. S.S. Concha; B. Patel; J. Okawa; L. M. Arkin; V. P. Werth

doi:10.1111/bjd.17012

Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in paediatric cutaneous lupus among paediatric dermatologists and rheumatologists

C. J. Kushner, M. Tarazi, R. G. Gaffney, R. Feng, K. Ardalan, H. A. Brandling-Bennett, L. Castelo-Soccio, J. C. Chang, Y. E. Chiu, S. Gmuca, R. D. Hunt, P. J. Kahn, A. M. Knight, J. Mehta, D. R. Pearson, J. R. Treat, J. Wan, A. C. Yeguez, J. S.S. Concha, B. PatelJ. Okawa, L. M. Arkin, V. P. Werth

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Abstract

Background: The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is a reliable outcome measure for cutaneous lupus erythematosus (CLE) in adults used in clinical trials. However, it has not been validated in children, limiting clinical trials for paediatric CLE. Objectives: This study aimed to validate the CLASI in paediatrics. Methods: Eleven paediatric patients with CLE, six dermatologists and six rheumatologists participated. The physicians were trained to use the CLASI and Physician's Global Assessment (PGA), and individually rated all patients using both tools. Each physician reassessed two randomly selected patients. Within each physician group, the intraclass correlation coefficient (ICC) was calculated to assess the reliability of each measure. Results: CLASI activity scores demonstrated excellent inter- and intrarater reliability (ICC > 0·90), while the PGA activity scores had good inter-rater reliability (ICC 0·73–0·77) among both specialties. PGA activity scores showed excellent (ICC 0·89) and good intrarater reliability (ICC 0·76) for dermatologists and rheumatologists, respectively. Limitations of this study include the small sample size of patients and potential recall bias during the physician rerating session. Conclusions: CLASI activity measurement showed excellent inter- and intrarater reliability in paediatric CLE and superiority over the PGA. These results demonstrate that the CLASI is a reliable and valid outcome instrument for paediatric CLE.

Original language	English (US)
Pages (from-to)	165-171
Number of pages	7
Journal	British Journal of Dermatology
Volume	180
Issue number	1
DOIs	https://doi.org/10.1111/bjd.17012
State	Published - Jan 2019
Externally published	Yes

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© 2018 British Association of Dermatologists

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Kushner, C. J., Tarazi, M., Gaffney, R. G., Feng, R., Ardalan, K., Brandling-Bennett, H. A., Castelo-Soccio, L., Chang, J. C., Chiu, Y. E., Gmuca, S., Hunt, R. D., Kahn, P. J., Knight, A. M., Mehta, J., Pearson, D. R., Treat, J. R., Wan, J., Yeguez, A. C., Concha, J. S. S., ... Werth, V. P. (2019). Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in paediatric cutaneous lupus among paediatric dermatologists and rheumatologists. British Journal of Dermatology, 180(1), 165-171. https://doi.org/10.1111/bjd.17012

Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in paediatric cutaneous lupus among paediatric dermatologists and rheumatologists. / Kushner, C. J.; Tarazi, M.; Gaffney, R. G. et al.
In: British Journal of Dermatology, Vol. 180, No. 1, 01.2019, p. 165-171.

Research output: Contribution to journal › Article › peer-review

Kushner, CJ, Tarazi, M, Gaffney, RG, Feng, R, Ardalan, K, Brandling-Bennett, HA, Castelo-Soccio, L, Chang, JC, Chiu, YE, Gmuca, S, Hunt, RD, Kahn, PJ, Knight, AM, Mehta, J, Pearson, DR, Treat, JR, Wan, J, Yeguez, AC, Concha, JSS, Patel, B, Okawa, J, Arkin, LM & Werth, VP 2019, 'Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in paediatric cutaneous lupus among paediatric dermatologists and rheumatologists', British Journal of Dermatology, vol. 180, no. 1, pp. 165-171. https://doi.org/10.1111/bjd.17012

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title = "Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in paediatric cutaneous lupus among paediatric dermatologists and rheumatologists",

abstract = "Background: The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is a reliable outcome measure for cutaneous lupus erythematosus (CLE) in adults used in clinical trials. However, it has not been validated in children, limiting clinical trials for paediatric CLE. Objectives: This study aimed to validate the CLASI in paediatrics. Methods: Eleven paediatric patients with CLE, six dermatologists and six rheumatologists participated. The physicians were trained to use the CLASI and Physician's Global Assessment (PGA), and individually rated all patients using both tools. Each physician reassessed two randomly selected patients. Within each physician group, the intraclass correlation coefficient (ICC) was calculated to assess the reliability of each measure. Results: CLASI activity scores demonstrated excellent inter- and intrarater reliability (ICC > 0·90), while the PGA activity scores had good inter-rater reliability (ICC 0·73–0·77) among both specialties. PGA activity scores showed excellent (ICC 0·89) and good intrarater reliability (ICC 0·76) for dermatologists and rheumatologists, respectively. Limitations of this study include the small sample size of patients and potential recall bias during the physician rerating session. Conclusions: CLASI activity measurement showed excellent inter- and intrarater reliability in paediatric CLE and superiority over the PGA. These results demonstrate that the CLASI is a reliable and valid outcome instrument for paediatric CLE.",

author = "Kushner, {C. J.} and M. Tarazi and Gaffney, {R. G.} and R. Feng and K. Ardalan and Brandling-Bennett, {H. A.} and L. Castelo-Soccio and Chang, {J. C.} and Chiu, {Y. E.} and S. Gmuca and Hunt, {R. D.} and Kahn, {P. J.} and Knight, {A. M.} and J. Mehta and Pearson, {D. R.} and Treat, {J. R.} and J. Wan and Yeguez, {A. C.} and Concha, {J. S.S.} and B. Patel and J. Okawa and Arkin, {L. M.} and Werth, {V. P.}",

note = "Publisher Copyright: {\textcopyright} 2018 British Association of Dermatologists",

year = "2019",

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doi = "10.1111/bjd.17012",

language = "English (US)",

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T1 - Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in paediatric cutaneous lupus among paediatric dermatologists and rheumatologists

AU - Kushner, C. J.

AU - Tarazi, M.

AU - Gaffney, R. G.

AU - Feng, R.

AU - Ardalan, K.

AU - Brandling-Bennett, H. A.

AU - Castelo-Soccio, L.

AU - Chang, J. C.

AU - Chiu, Y. E.

AU - Gmuca, S.

AU - Hunt, R. D.

AU - Kahn, P. J.

AU - Knight, A. M.

AU - Mehta, J.

AU - Pearson, D. R.

AU - Treat, J. R.

AU - Wan, J.

AU - Yeguez, A. C.

AU - Concha, J. S.S.

AU - Patel, B.

AU - Okawa, J.

AU - Arkin, L. M.

AU - Werth, V. P.

PY - 2019/1

Y1 - 2019/1

N2 - Background: The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is a reliable outcome measure for cutaneous lupus erythematosus (CLE) in adults used in clinical trials. However, it has not been validated in children, limiting clinical trials for paediatric CLE. Objectives: This study aimed to validate the CLASI in paediatrics. Methods: Eleven paediatric patients with CLE, six dermatologists and six rheumatologists participated. The physicians were trained to use the CLASI and Physician's Global Assessment (PGA), and individually rated all patients using both tools. Each physician reassessed two randomly selected patients. Within each physician group, the intraclass correlation coefficient (ICC) was calculated to assess the reliability of each measure. Results: CLASI activity scores demonstrated excellent inter- and intrarater reliability (ICC > 0·90), while the PGA activity scores had good inter-rater reliability (ICC 0·73–0·77) among both specialties. PGA activity scores showed excellent (ICC 0·89) and good intrarater reliability (ICC 0·76) for dermatologists and rheumatologists, respectively. Limitations of this study include the small sample size of patients and potential recall bias during the physician rerating session. Conclusions: CLASI activity measurement showed excellent inter- and intrarater reliability in paediatric CLE and superiority over the PGA. These results demonstrate that the CLASI is a reliable and valid outcome instrument for paediatric CLE.

AB - Background: The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is a reliable outcome measure for cutaneous lupus erythematosus (CLE) in adults used in clinical trials. However, it has not been validated in children, limiting clinical trials for paediatric CLE. Objectives: This study aimed to validate the CLASI in paediatrics. Methods: Eleven paediatric patients with CLE, six dermatologists and six rheumatologists participated. The physicians were trained to use the CLASI and Physician's Global Assessment (PGA), and individually rated all patients using both tools. Each physician reassessed two randomly selected patients. Within each physician group, the intraclass correlation coefficient (ICC) was calculated to assess the reliability of each measure. Results: CLASI activity scores demonstrated excellent inter- and intrarater reliability (ICC > 0·90), while the PGA activity scores had good inter-rater reliability (ICC 0·73–0·77) among both specialties. PGA activity scores showed excellent (ICC 0·89) and good intrarater reliability (ICC 0·76) for dermatologists and rheumatologists, respectively. Limitations of this study include the small sample size of patients and potential recall bias during the physician rerating session. Conclusions: CLASI activity measurement showed excellent inter- and intrarater reliability in paediatric CLE and superiority over the PGA. These results demonstrate that the CLASI is a reliable and valid outcome instrument for paediatric CLE.

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Evaluation of the reliability and validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) in paediatric cutaneous lupus among paediatric dermatologists and rheumatologists

Abstract

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