Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A.
Br J Dermatol. 2020 Feb;182(2):398-404. doi: 10.1111/bjd.18097. Epub 2019 Aug 14.
Validated scoring measures in morphoea can facilitate clinical trials.
To ascertain the clinical significance of scores on the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) and identify the change in scores correlated with clinically meaningful change.
A prospective study of 120 participants from the Morphea in Adults and Children (MAC) cohort was undertaken. Physician's subjective assessments of severity and of improvement were completed at each visit. Receiver operating characteristic analysis determined LoSCAT scores corresponding with mild, moderate and severe disease, and absolute and percentage changes in scores corresponding with improved or worsened disease activity or damage.
Mild, moderate and severe activity corresponded with LoSCAT activity index (LoSAI) scores of 0-4, 5-12 and 13 and over, and with Physician's Global Assessment of activity (PGA-A) scores of 0-10, 11-30 and 31 and over. Mild, moderate and severe damage corresponded with LoSCAT damage index (LoSDI) scores of 0-10, 11-15 and 16 and over, and with PGA of damage (PGA-D) scores of 0-18, 19-30 and 31 and over. Improved activity was best indicated by LoSAI decrease of at least 2 points or 27·5%, or PGA-A decrease of at least 6 points. Improved damage was best indicated by LoSDI score decrease of at least 2 points. Worsening activity was best indicated by LoSAI increase of at least 2 points or 19·5%, or PGA-A increase of at least 4 points. Worsening damage was best indicated by LoSDI increase of at least 25·5%.
The LoSCAT can be used to classify patients with morphoea by disease severity, and identify clinically significant improvement in activity. What's already known about this topic? The Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) is a clinical tool that separately quantifies disease activity and damage in morphoea, and prior studies have demonstrated validity and reliability. What does this study add? The LoSCAT can be used to classify patients with morphoea by disease severity into mild, moderate and severe groups, and to identify clinically significant improvement in disease activity in patients with morphoea. The LoSCAT may be limited in its ability to detect clinically significant changes in disease damage.
在硬皮病中，经过验证的评分量表可以促进临床试验。
确定局部硬皮病皮肤评估工具（LoSCAT）评分的临床意义，并确定与临床有意义的变化相关的评分变化。
对成人和儿童硬皮病（MAC）队列中的 120 名参与者进行前瞻性研究。每次就诊时，医生都会完成对严重程度和改善情况的主观评估。接收者操作特征分析确定了与轻度、中度和重度疾病相对应的 LoSCAT 评分，以及与疾病活动或损伤改善或恶化相对应的评分的绝对和百分比变化。
轻度、中度和重度活动与 LoSCAT 活动指数（LoSAI）评分 0-4、5-12 和 13 及以上，以及医生整体活动评估（PGA-A）评分 0-10、11-30 和 31 及以上相对应；轻度、中度和重度损伤与 LoSCAT 损伤指数（LoSDI）评分 0-10、11-15 和 16 及以上，以及 PGA 损伤评分（PGA-D）评分 0-18、19-30 和 31 及以上相对应。LoSAI 评分至少降低 2 分或 27.5%，或 PGA-A 评分至少降低 6 分，表明活动改善最佳；LoSDI 评分至少降低 2 分，表明损伤改善最佳。LoSAI 评分至少增加 2 分或 19.5%，或 PGA-A 评分至少增加 4 分，表明活动恶化最佳；LoSDI 评分至少增加 25.5%，表明损伤恶化最佳。
LoSCAT 可用于根据疾病严重程度对硬皮病患者进行分类，并确定活动的临床显著改善。
关于这个主题已经知道些什么？局部硬皮病皮肤评估工具（LoSCAT）是一种单独量化硬皮病患者疾病活动和损伤的临床工具，先前的研究已经证明了其有效性和可靠性。这项研究增加了什么？LoSCAT 可用于根据疾病严重程度将硬皮病患者分为轻度、中度和重度组，并确定硬皮病患者疾病活动的临床显著改善。LoSCAT 可能在检测疾病损伤的临床显著变化方面存在局限性。
