Background/Purpose:

SLE is a chronic autoimmune disease with variable manifestations. New developments in the understanding and treatment of SLE mandated closer monitoring of the disease activity and its response to treatment. Current disease activity indices (e.g. SLEDAI SELENA, BILAG & SLAM) have their own limitations. We designed a new disease activity evaluation tool: the Lupus Activity Scoring Tool (LAST) that simplifies the approach to quantify SLE activity while maintaining high sensitivity. We have also developed an easy to use electronic application of this tool.

Primary: To validate a SLE activity tool with it correlation to the SLEDAI SELENA modification. Secondary: To test the usability and the accuracy of electronic applications of the same tool in clinical settings.

Methods:

The new disease activity tracking and evaluating tool included patient global assessment of disease activity (PGA), physician global assessment of disease activity (PHGA), and a formula incorporating the current immunomodulating medication used as an indication of SLE activity. The LAST included C3, C4 and Anti-ds Anti-DNA titer abnormalities as activity indicators. Patients who met the SLE ACR 1997 criteria update were seen in a rheumatology clinic within the last 12 months and had the laboratory investigations done within 2 weeks of their visit. The SLEDAI was calculated for each visit. Five different systems (algorithms) of weighting the different variables of disease activity were calculated. Apple iPad and Windows web-based applications were developed for the LAST and a clinical only LAST (without incorporating serological values). Descriptive statistics and correlation bivariates (Pearson’s & Spearman’s) were conducted. Each algorithm result and the disease activity of patients with multiple assessments were compared to the SLEDAI SELENA scores.

Results:

Twenty three patients (91% females) with 43 assessments were included. Scores from 5 algorithms of the variables in addition to the SLEDAI SELENA scores were obtained at each visit. The mean (SD) age was 47.97 (14.61) years and the mean (SD) of disease duration was 12.26 (6.47) years. The mean (SD) SLEDAI score was 6.30 (4.01). The mean (SD) LAST (with C3, C4 and Anti-ds DNA) score was 39.85 (18.67). The correlation between the two new activity indices was very high: 0.920 with p<0.001. The SLEDAI scores were consistent with the LAST scores at the baseline and follow-up visits: SLEDAI scores 0-4 corresponded to the LAST scores of 0-30 while SLEDAI 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 correlated well with the SLEDAI SELENA modification. The use of simple clinical variables as a measure of SLE activity seems to be valid. The development of easy to use electronic apps will make the use of these activity tracking tools easier to calculate and can be possibly utilized in non-specialist settings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-validation-of-a-new-simple-disease-activity-tool-in-systemic-lupus-erythematosus-sle-the-lupus-activity-scoring-tool-last-as-compared-to-the-sledai-selena-modification/