Background/Purpose:

Systemic Lupus Erythematosus (SLE) is a chronic immune modulated disease with variable clinical manifestations. New advances in the management of SLE mandated closer monitoring of the disease activity and its response to treatment. Current disease activity indices (e.g. SELENA SLEDAI, BILAG & SLAM) have their own limitations.

In our centre, a new tool for the assessment of SLE activity: the  Lupus Activity Scoring Tool (LAST) was developed and validated. This tool simplifies the approach to quantifying SLE activity while maintaining high sensivity. This study was designed to validate this tool in different clinical settings. Apple iPad and Windows web-based applications were developed for the LAST.

We aimed:  To validate the LAST in multiple clinical settings using its correlation to the SELENA SLEDAI modification. To test the usability and the accuracy of an electronic application of the same tool.

Methods:

This multicenter study was initiated in four Canadian clinics: two in Newfoundland and two in Ontario. The LAST included patient global assessment of disease activity (PGA), physician global assessment of disease activity (PHGA), C3, C4 and Anti-ds Anti-DNA titer abnormalities, and a formula incorporating the current immunomodulating medication used as an indication of SLE activity. Patients who met the SLE ACR 1997 criteria update were  recruited and evaluated in the study centres using LAST. Some of the patients were prospectively followed and evaluated by the same tool at each visit. The SS was also calculated for each visit. Descriptive statistics and correlation bivariates were conducted. The LAST scores of the disease activity of patients with multiple assessments were compared to the SS scores.

Results:

Thirty two patients (91% females) with 66 assessments from four study centers were included in this analysis. The mean (SD) age was 46.3 (14.7) years and the mean (SD) of disease duration was 13.6 (6.1) years. Scores from the LAST were obtained at each visit in addition to the SLEDAI scores. The mean (SD) SLEDAI score was 6.6 (3.9). The mean (SD) LAST (with C3, C4 and Anti-ds Anti-DNA) score was 34.9 (18.2). The SLEDAI scores were consistent and strongly correlated (r=0.791; p<0.001) with the LAST scores at the baseline and follow-up visits: SS scores 0-4 corresponded to the LAST scores of 0-30 while SS scores of 8 or higher corresponded to 50 and higher, respectively. The electronic applications of the LAST were easy to use and no errors were found with their results as compared to the manually obtained scores.

Conclusion:

The Lupus Activity Scoring Tool (LAST) is a new disease activity index that correlates well with the SELENA SLEDAI modification. The use of simple clinical variables as a measure of SLE activity seems to be valid under different clinical settings with different assessors. The development of easy to use electronic apps will make the use of these activity tracking tools simpler and can possibly be utilized in non-specialist settings.

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« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/multicenter-validation-of-the-lupus-activity-scoring-tool-last-as-compared-to-the-selena-sledai-ss-modification/