Date: Sunday, November 8, 2015
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Assessment of systemic lupus erythematosus (SLE) is complex due to its heterogeneous manifestations and its fluctuant clinical course. Current instruments stressed one specific aspect of disease activity such as improvement, flares or ongoing activity, but clinicians should evaluate all these aspects with one-single instrument. We designed a new instrument based on classic lupus descriptors but we added parameters such as treatment modifications and changes in physician global assessment (PGA). Here we present our preliminary results.
A cross-sectional study was performed. All the patients satisfied the 2012 SLICC classification criteria for SLE. The instrument was based on thirty descriptors grouped in one of the following categories: clinical activity (CA) (visceral, mucocutaneous and articular involvement and constitutional symptoms), physician global assessment (PGA) (0 to 3), biologic activity (BA) (SLE autoantibodies and erythrocyte sedimentation rate (ESR)) and treatment (T) (corticosteroids, DMARDs and biologic treatment). A positive score (+1 to +4) was assigned according to descriptor severity. A negative score (-1 to -3) was assigned whether both a reduction in PGA or in treatment was verified in the last month. A comparison with both SLEDAI score and SELENA-SLEDAI flare index (SFI) was performed by T test and linear regression analyses.
Fifty-two SLE patients were included, 94.5% were females. Mean age was 45.1 (± 13.9) years. Lupus nephritis was recorded in 13.4% of patients. Mean SLEDAI was 4.85 (± 2.4) and the mean value of the new instrument was 5.12 (± 3.42). A good correlation with SLEDAI was noted (r= 0.8, CI95% 0.63-0.89, p< 0.001). Thirteen patients (25%) experienced at least 1 episode of severe flare according to SFI. In those patients where a severe flare was retained by an increase of SLEDAI of more of 12 points, an increase of 15.4 (± 3.6) points was noted in the new instrument. Remarkably, in the group of patients where a severe flare was retained by steroid / immunossuppresor introduction or hospitalization, SLEDAI increased only by 5.4 (± 2.2). By contrast the new instrument showed a mean increase of 16 (±1.4) points.
These preliminary data show that this new instrument has a good correlation with SLEDAI score and it is sensitive to recognize flare episodes that are not retained by an increase in SLEDAI. The performance of this instrument must be tested in a longitudinal cohort. Our future goal is to assess SLE recognizing persistent activity, flares and improvements through a one-single instrument.
To cite this abstract in AMA style:Espinoza F Sr., Kalunian K. A Proposal for Assessing Systemic Lupus Erythematosus Activity By a Multimodal Instrument That Includes Clinical Variables, Physician Assessment and Modification of Treatment [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/a-proposal-for-assessing-systemic-lupus-erythematosus-activity-by-a-multimodal-instrument-that-includes-clinical-variables-physician-assessment-and-modification-of-treatment/. Accessed January 27, 2020.
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