Limits...
Preliminary test of the LFA rapid evaluation of activity in lupus (LFA-REAL): an efficient outcome measure correlates with validated instruments.

Askanase A, Li X, Pong A, Shum K, Kamp S, Carthen F, Aberle T, Hanrahan L, Daly P, Giles J, Merrill JT - Lupus Sci Med (2015)

Bottom Line: The median SS-PGA score of this group was 66 mm (50-92) versus median REAL score of 100 mm (59-268), confirming ability to detect a wider distribution of scores at higher disease activity.Individual LFA-REAL organ scores for musculoskeletal and mucocutaneous also correlated with corresponding BILAG domain scores (correlation coefficient=0.925 and 0.934, p<0.001).In this preliminary exercise, there were strong correlations between LFA-REAL and validated lupus disease activity indices.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine , Columbia University Medical Center , New York, New York , USA.

ABSTRACT

Objective: Current disease activity measures for systemic lupus erythematosus (SLE) are difficult to score or interpret and problematic for use in clinical practice. Lupus Foundation of America (LFA)-Rapid Evaluation of Activity in Lupus (REAL) is a pilot application composed of anchored visual analogue scores (0-100 mm each) for each organ affected by lupus. This study evaluated the use of LFA-REAL in capturing SLE disease activity.

Methods: In a preliminary test of LFA-REAL, this simplified, organ-based system was compared with the most widely used outcome measures in clinical trials, the British Isles Lupus Assessment Group 2004 Index (BILAG), the SLE Disease Activity Index (SLEDAI) and the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) SLEDAI Physician's Global Assessment (SS-PGA). The level of agreement was analysed using Spearman rank correlations.

Results: 91 patients with SLE with mild to severe disease activity were evaluated, their median SLEDAI score was 4.0 (range 0-28) and BILAG score 8.0 (0-32). The median SS-PGA was 38 mm (4-92) versus the total REAL 50 mm (0-268), which expands in range by additive organ scores. Thirty-three patients had moderate to severe disease activity (≥1.5 on SS-PGA landmarks). The median SS-PGA score of this group was 66 mm (50-92) versus median REAL score of 100 mm (59-268), confirming ability to detect a wider distribution of scores at higher disease activity. Total REAL correlated with SLEDAI, BILAG and SS-PGA (correlation coefficient=0.816, 0.933 and 0.903, respectively; p<0.001 for all). Individual LFA-REAL organ scores for musculoskeletal and mucocutaneous also correlated with corresponding BILAG domain scores (correlation coefficient=0.925 and 0.934, p<0.001).

Conclusions: In this preliminary exercise, there were strong correlations between LFA-REAL and validated lupus disease activity indices. Further development may be valuable for consistent scoring in clinical trials, grading optimal assessment of change in disease activity and reliable monitoring of patients in practice.

No MeSH data available.


Related in: MedlinePlus

Lupus Foundation of America-Rapid Evaluation of Activity in Lupus (LFA-REAL) comprised seven anchored Visual Analogue Scales (0–100 mm each) and can describe both organ-specific and overall disease progress. SLEDAI, Systemic Lupus Erythematosus Disease Activity Index.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4378376&req=5

LUPUS2014000075F1: Lupus Foundation of America-Rapid Evaluation of Activity in Lupus (LFA-REAL) comprised seven anchored Visual Analogue Scales (0–100 mm each) and can describe both organ-specific and overall disease progress. SLEDAI, Systemic Lupus Erythematosus Disease Activity Index.

Mentions: The LFA-REAL (figure 1) has six or more anchored Visual Analogue Scales (VASs; 0–100 mm each): the first six assess the most commonly affected organs (mucocutaneous, musculoskeletal, cardiorespiratory, neuropsychiatric, renal and haematological); ‘other’ scales can be added to record features that do not fit the six categories above or to separately score each descriptor in organs with two or more manifestations (eg, discoid rash and cutaneous vasculitis or pleurisy and pericarditis). It is a rapid system because only active disease requires scoring and it is unlikely to find more than three or four active manifestations at once in most patients. The landmarks are identical to the SS-PGA: 0=none, 1=mild, 2=moderate and 3=severe (figure 1). An anchor at 1.5 was added to serve as a potential cut-off for the initiation of immunosupressants. Each investigator checked the length of the instrument before use. Copies of the instrument with scales not equalled to 100 mm were discarded. Each scale was measured with a study-specific 10 cm ruler. In every case, when used in the study, the instrument was scored in <60 s. However, this needs to be confirmed with other users.


Preliminary test of the LFA rapid evaluation of activity in lupus (LFA-REAL): an efficient outcome measure correlates with validated instruments.

Askanase A, Li X, Pong A, Shum K, Kamp S, Carthen F, Aberle T, Hanrahan L, Daly P, Giles J, Merrill JT - Lupus Sci Med (2015)

Lupus Foundation of America-Rapid Evaluation of Activity in Lupus (LFA-REAL) comprised seven anchored Visual Analogue Scales (0–100 mm each) and can describe both organ-specific and overall disease progress. SLEDAI, Systemic Lupus Erythematosus Disease Activity Index.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4378376&req=5

LUPUS2014000075F1: Lupus Foundation of America-Rapid Evaluation of Activity in Lupus (LFA-REAL) comprised seven anchored Visual Analogue Scales (0–100 mm each) and can describe both organ-specific and overall disease progress. SLEDAI, Systemic Lupus Erythematosus Disease Activity Index.
Mentions: The LFA-REAL (figure 1) has six or more anchored Visual Analogue Scales (VASs; 0–100 mm each): the first six assess the most commonly affected organs (mucocutaneous, musculoskeletal, cardiorespiratory, neuropsychiatric, renal and haematological); ‘other’ scales can be added to record features that do not fit the six categories above or to separately score each descriptor in organs with two or more manifestations (eg, discoid rash and cutaneous vasculitis or pleurisy and pericarditis). It is a rapid system because only active disease requires scoring and it is unlikely to find more than three or four active manifestations at once in most patients. The landmarks are identical to the SS-PGA: 0=none, 1=mild, 2=moderate and 3=severe (figure 1). An anchor at 1.5 was added to serve as a potential cut-off for the initiation of immunosupressants. Each investigator checked the length of the instrument before use. Copies of the instrument with scales not equalled to 100 mm were discarded. Each scale was measured with a study-specific 10 cm ruler. In every case, when used in the study, the instrument was scored in <60 s. However, this needs to be confirmed with other users.

Bottom Line: The median SS-PGA score of this group was 66 mm (50-92) versus median REAL score of 100 mm (59-268), confirming ability to detect a wider distribution of scores at higher disease activity.Individual LFA-REAL organ scores for musculoskeletal and mucocutaneous also correlated with corresponding BILAG domain scores (correlation coefficient=0.925 and 0.934, p<0.001).In this preliminary exercise, there were strong correlations between LFA-REAL and validated lupus disease activity indices.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine , Columbia University Medical Center , New York, New York , USA.

ABSTRACT

Objective: Current disease activity measures for systemic lupus erythematosus (SLE) are difficult to score or interpret and problematic for use in clinical practice. Lupus Foundation of America (LFA)-Rapid Evaluation of Activity in Lupus (REAL) is a pilot application composed of anchored visual analogue scores (0-100 mm each) for each organ affected by lupus. This study evaluated the use of LFA-REAL in capturing SLE disease activity.

Methods: In a preliminary test of LFA-REAL, this simplified, organ-based system was compared with the most widely used outcome measures in clinical trials, the British Isles Lupus Assessment Group 2004 Index (BILAG), the SLE Disease Activity Index (SLEDAI) and the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) SLEDAI Physician's Global Assessment (SS-PGA). The level of agreement was analysed using Spearman rank correlations.

Results: 91 patients with SLE with mild to severe disease activity were evaluated, their median SLEDAI score was 4.0 (range 0-28) and BILAG score 8.0 (0-32). The median SS-PGA was 38 mm (4-92) versus the total REAL 50 mm (0-268), which expands in range by additive organ scores. Thirty-three patients had moderate to severe disease activity (≥1.5 on SS-PGA landmarks). The median SS-PGA score of this group was 66 mm (50-92) versus median REAL score of 100 mm (59-268), confirming ability to detect a wider distribution of scores at higher disease activity. Total REAL correlated with SLEDAI, BILAG and SS-PGA (correlation coefficient=0.816, 0.933 and 0.903, respectively; p<0.001 for all). Individual LFA-REAL organ scores for musculoskeletal and mucocutaneous also correlated with corresponding BILAG domain scores (correlation coefficient=0.925 and 0.934, p<0.001).

Conclusions: In this preliminary exercise, there were strong correlations between LFA-REAL and validated lupus disease activity indices. Further development may be valuable for consistent scoring in clinical trials, grading optimal assessment of change in disease activity and reliable monitoring of patients in practice.

No MeSH data available.


Related in: MedlinePlus