Session Information
Date: Sunday, November 8, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session I
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Current SLE disease
activity measures, such as SLEDAI and BILAG, can be challenging to score and interpret,
making them impractical for use in a busy clinic and difficult to evaluate when
used as outcomes in clinical trials. The LFA- REAL is composed of individual visual
analog scales (0-100mm each) representing different manifestations of SLE. A clinician
can quickly rate only the active features in a given patient, immediately generating
organ-specific as well as total disease activity scores. The objective of this study was to
compare LFA-REAL scores between clinical investigators (investigators) trained
in scoring SLE disease activity instruments and clinicians without specialized SLE
instrument training (clinicians), and to correlate REAL scores with other
disease activity measures.
Methods: 99 SLE patients in four rheumatology
clinics were evaluated, of whom 70 returned for an additional follow-up assessment. At each visit, an investigator scored
SLEDAI, BILAG, PGA, and LFA-REAL and a clinician scored only the LFA-REAL. Level
of agreement was determined by Spearman rank correlations.
Results : The study included 93% women, 31%
Caucasian, mean age 43.4 years, mean disease duration 10 years. Mean (SD) of
the disease activity
scores for the first and second visits are shown below. There was excellent
correlation between the clinician and investigator REAL scores at both visits (ρ=0.80 for visit 1; 0.86 for visit 2).
|
SLEDAI |
BILAG |
PGA |
REAL |
||
|
Visit 1 |
Investigator |
5.5 (4.5) |
6.7 (7.8) |
33.6 (24.5) |
46.2 (42.9) |
|
Clinician |
—
|
—
|
—
|
56.1 (53.6) |
|
|
Visit 2 |
Investigator |
5.2 (5.2) |
6.0 (9.1) |
31.9 (21.2) |
41. 3 (36.7) |
|
Clinician |
—
|
—
|
—
|
48.3 (42.6) |
Global REAL scores
also correlated well with the PGA, SLEDAI, and BILAG.
|
SLEDAI (ρ) |
BILAG (ρ) |
PGA (ρ) |
|
|
Visit 1 Investigator REAL Clinician REAL |
0.70 0.58 |
0.86 0.70 |
0.79 0.63 |
|
Visit 2 Investigator REAL Clinician REAL |
0.72 0.58 |
0.88 0.81 |
0.81 0.63 |
|
Change (V2-V1) Investigator REAL Clinician REAL |
0.63 0.56 |
0.61 0.42 |
0.80 0.50 |
Organ specific correlations between the REAL and
individual BILAG organs were > 0.7 for musculoskeletal, mucocutaneous and
renal domains, for both investigators and clinicians.
Conclusion:
The LFA-REAL shows promise as an efficient tool
for clinical trials and for accurate monitoring of patient progress by busy clinicians
without special instrument training. Community input, refinement and formal
validation is planned to optimize the format, consistency and applicability of
the instrument.
To cite this abstract in AMA style:
Askanase A, Kapoor T, Aranow C, Costenbader KH, Grossman J, Kamen DL, Lim SS, Kim M, Daly P, Hanrahan LM, Merrill JT. The Lupus Foundation of America Rapid Evaluation of Activity in Lupus (LFA-REAL) Instrument Correlates Between Trained Clinical Investigators and Clinicians [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-lupus-foundation-of-america-rapid-evaluation-of-activity-in-lupus-lfa-real-instrument-correlates-between-trained-clinical-investigators-and-clinicians/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-lupus-foundation-of-america-rapid-evaluation-of-activity-in-lupus-lfa-real-instrument-correlates-between-trained-clinical-investigators-and-clinicians/