Background/Purpose

In our centre, new tools for the assessment of SLE activity: the  Lupus Activity Scoring Tool (LAST) and Clinical Lupus Activity Scoring Tool (C-LAST) were developed and validated. We aimed to validate the LAST and C-LAST in multiple clinical settings using their  correlation to the SELENA SLEDAI modification, and to investigate the correlation of the specific components of the LAST (e.g. patient’s and physician’s global assessments of disease activity, steroid use) to the SS.

Methods

This multicenter study was initiated in five Canadian clinics: 3 in Newfoundland and 2 in Ontario. The LAST includes patient (PGA)and physician global assessment of disease activity (PHGA), C3, C4 and Anti-ds Anti-DNA titer abnormalities, and a formula incorporating the current immunomodulating medication. The C-LAST does not include laboratory test results. Patients who met the SLE ACR 1997 criteria update were  recruited and evaluated in the study centres using LAST/C-LAST. Some of the patients were prospectively followed and evaluated by the same tools at each visit. The SS was also calculated for each visit.

Results

Fifty-eight patients (84.5% females) with 98 assessments from five study centers were included in this analysis. The median age was 49.0 (Q1-Q3=33.8-60.3) years with the mean (SD) disease duration 12.1 (6.5) years. Scores from the LAST/C-LAST were obtained at each visit in addition to the SLEDAI scores. The mean (SD) SLEDAI score was 8.2 (5.2). The mean (SD) LAST (with C3, C4 and Anti-ds Anti-DNA) score was 30.5 (17.3) and C-LAST – 32.2 (20.1). The SS scores were consistent and strongly correlated with the LAST and C-LAST scores (r=0.430, p<0.001 & r=0.215, p=0.034, respectively) 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. Both SS and LAST scores were significantly correlated with current treatment with Prednisone (r=0.305, p=0.002 & r=0.430, p<0.001, respectively); LAST score was also correlated with Mycophenolate mofetil (r=0.205, p=0.043) and Azathioprine (r=0.296, p=0.003) treatments. Patient’s (PGA) and Physician’s (PHGA) Global Assessments of SLE activity were strongly correlated with each other (r=0.759, p<0.001) and with the LAST score (r=0.781, p<0.001 & r=0.826, p<0.001, respectively); PHGA was also significantly correlated with SELENA SLEDAI score (r=0.324, p=0.001). The LAST and C-LAST scores concurred in 90% of the assessments with r=0.898 and p<0.001.

We utilized an electronic application of the LAST which was easy to use and no errors were found with its results as compared to the manually obtained scores with the Pearson’s correlation coefficient r=0.995 & p<0.001.

Conclusion

The Lupus Activity Scoring Tool (LAST) and C-LAST are new disease activity indices that correlate 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 inclusion of patient’s global assessment and the current use of steroids and immunomodulators can be utilized effectively in assessing disease activity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-validity-of-patient-and-physician-global-disease-activity-assessments-of-systemic-lupus-erythematosus-results-from-the-lupus-activity-scoring-tool-last-as-compared-to-the-selena-sledai-ss-mod/