ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1252

Physician Global Assessment of Disease Activity in Childhood-Onset Systemic Lupus Erythematosus – Does the Approach Matter?

Ekemini Ogbu1, Hermine Brunner2, Jennifer Huggins3, Angela Merritt3, Megan Quilan-Waters3, Catherine Robben3, Chen Chen3, Daniel J Lovell4 and Bin Huang3, 1Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Johns Hopkins University, Cincinnati, OH, 2Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, OH, 3Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 4UC Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, OH

Meeting: ACR Convergence 2023

Keywords: , ,

Session Information

Date: Monday, November 13, 2023

Title: (1221–1255) Pediatric Rheumatology – Clinical Poster II: Connective Tissue Disease

Session Type: Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Physician Global Assessment of Disease Activity (PhGA) are commonly used outcome measures in pediatric rheumatology. For childhood-onset systemic lupus erythematosus (cSLE), the traditional visual analog scale (range: 0 – 10; 0=inactive; 10=very active; PhGA0-10) but also the SELENA-SLEDAI (range: 0-3; 0= none, 1=mild, 2=moderate, 3=severe; PhGA0-3) are used to measure treatment response, flare, and Lupus Low Disease Activity Status (LLDAS) with PhGA0-3 ≤1. Thus, the purpose of this study was to compare the measurement properties of the PhGA0-10 and the PhGA0-3 in cSLE and with scores of the SLEDAI-2k, and the SELENA-SLEDAI.

Methods: Secondary data analysis from a convenience sample of 100 cSLE followed every 3 months for up to 7 visits (1). Ratings of PhGA0-10, PhGA0-3, parent assessment of patient well-being (ParGA; range: 0= very poorly, 10=very well), SLEDAI-2k and SELENA-SLEDAI were compared. After linear transformation of PhGA0-10 to a 0-3 range (tPhGA0-10) frequency of PhGA0-3≤1 were compared.

Results: In 601 visits, mean (SD)/median (range) of PhGA0-10, PhGA0-3, SLEDAI-2K and SELENA-SLEDAI were 2.13 (1.87)/2 (0-10), 0.79 (0.64)/1(0-3), 4.63 (4.14)/ 4 (0-28) and 4.51 (4.1) / 4 (0-32) respectively. PhGA0-10 were moderately correlated with PhGA0-3 (r=0.73; p< 0.0001; Figure 1) with more variability for PhGA0-3 ≥2. ParGA was weakly correlated with PhGA0-10, PhGA0-3, SLEDAI-2k and SELENA-SLEDAI scores (r = -0.34, -0.30, -0.19 and -0.20). SELENA-SLEDAI and SLEDAI-2k scores were highly (r=0.98) correlated with each other. However, SLEDAI-2K/SELENA-SLEDAI scores were weakly correlated with PhGA0-3 (r=0.28/0.28; p < .001) and moderately correlated with PhGA0-10 (r= 0.56/0.54; p < .0001). There were 490/497 of 601 visits with PhGA0-3 ≤1 / tPhGA0-10 ≤1 [Kappa (SE) =0.59 (0.04), McNemar p=0.4].

Conclusion: Using the traditional PhGA0-10 in cSLE yields almost identical LLDAS rates compared to the PhGA0-3. Given its closer association with the scores of disease activity indices in cSLE, use of the PhGA0-10 may be preferable in pediatric populations.

References: (1) Mina R, Klein-Gitelman MS, Nelson S, Eberhard BA, Higgins G, Singer NG, Onel K, Tucker L, O’Neil KM, Punaro M, Levy DM, Haines K, Martini A, Ruperto N, Lovell D, Brunner HI. Validation of the systemic lupus erythematosus responder index for use in juvenile-onset systemic lupus erythematosus. Ann Rheum Dis. 2014 Feb;73(2):401-6. PMID: 23345596.

Supporting image 1

Figure 1: Relationship of Physician Global Assessment of Disease Activity traditional visual analog scale (PhGA0_10) with the SELENA-SLEDAI scale (PhGA0_3)

Disclosures: E. Ogbu: None; H. Brunner: AbbVie, 2, AstraZeneca-Medimmune, 2, Biogen, 2, Boehringer-Ingelheim, 2, Bristol-Myers Squibb (BMS), 2, 5, Celgene, 2, Eli Lilly, 2, 5, EMD Serono, 2, F-Hoffman La Roche, 2, 5, GlaxoSmithKlein (GSK), 2, 5, 6, Horizon, 2, 2, Janssen, 5, Merck, 2, Novartis, 2, 5, 6, Pfizer, 2, 5, 6; J. Huggins: None; A. Merritt: None; M. Quilan-Waters: None; C. Robben: None; C. Chen: None; D. Lovell: Abbott, 2, 6, AbbVie, 2, Amgen, 2, AstraZeneca, 2, Boehringer-Ingelheim, 2, Bristol-Myers Squibb(BMS), 2, Canadian Arthritis Society, 1, Celgene, 2, Forest Research, 1, GlaxoSmithKlein(GSK), 2, Hoffmann-La Roche, 2, Janssen, 2, NIH-NIAMS, 1, Novartis, 2, 6, Pfizer, 2, United Bioscience Corporation, 2, Wyeth, 2; B. Huang: None.

To cite this abstract in AMA style:

Ogbu E, Brunner H, Huggins J, Merritt A, Quilan-Waters M, Robben C, Chen C, Lovell D, Huang B. Physician Global Assessment of Disease Activity in Childhood-Onset Systemic Lupus Erythematosus – Does the Approach Matter? [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/physician-global-assessment-of-disease-activity-in-childhood-onset-systemic-lupus-erythematosus-does-the-approach-matter/. Accessed .

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