Journal article
Study of Flare Assessment in Systemic Lupus Erythematosus Based on Paper Patients
Arthritis care & research (2010), v 70(1), pp 98-103
Jan 2018
PMID: 28388813
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objective
To determine the level of agreement of disease flare severity (distinguishing severe, moderate, and mild flare and persistent disease activity) in a large paper‐patient exercise involving 988 individual cases of systemic lupus erythematosus.
Methods
A total of 988 individual lupus case histories were assessed by 3 individual physicians. Complete agreement about the degree of flare (or persistent disease activity) was obtained in 451 cases (46%), and these provided the reference standard for the second part of the study. This component used 3 flare activity instruments (the British Isles Lupus Assessment Group [BILAG] 2004, Safety of Estrogens in Lupus Erythematosus National Assessment [SELENA] flare index [SFI] and the revised SELENA flare index [rSFI]). The 451 patient case histories were distributed to 18 pairs of physicians, carefully randomized in a manner designed to ensure a fair case mix and equal distribution of flare according to severity.
Results
The 3‐physician assessment of flare matched the level of flare using the 3 indices, with 67% for BILAG 2004, 72% for SFI, and 70% for rSFI. The corresponding weighted kappa coefficients for each instrument were 0.82, 0.59, and 0.74, respectively. We undertook a detailed analysis of the discrepant cases and several factors emerged, including a tendency to score moderate flares as severe and persistent activity as flare, especially when the SFI and rSFI instruments were used. Overscoring was also driven by scoring treatment change as flare, even if there were no new or worsening clinical features.
Conclusion
Given the complexity of assessing lupus flare, we were encouraged by the overall results reported. However, the problem of capturing lupus flare accurately is not completely solved.
Metrics
Details
- Title
- Study of Flare Assessment in Systemic Lupus Erythematosus Based on Paper Patients
- Creators
- D. Isenberg - University College LondonJ. Sturgess - Hospital for Tropical DiseasesE. Allen - Hospital for Tropical DiseasesC. Aranow - Feinstein Institute for Medical ResearchA. Askanase - Columbia UniversityB. Sang-Cheol - Hanyang University Seoul HospitalS. Bernatsky - McGill UniversityI. Bruce - Manchester Academic Health Science CentreJ. Buyon - New York School of MedicineR. Cervera - Universitat de BarcelonaA. Clarke - University of CalgaryMary Anne Dooley - University of North Carolina at Chapel HillP. Fortin - Université LavalE. Ginzler - SUNY Downstate Health Sciences UniversityD. Gladman - Toronto Western HospitalJ. Hanly - Nova Scotia HospitalM. Inanc - Istanbul UniversityS. Jacobsen - RigshospitaletD. Kamen - Medical University of South CarolinaM. Khamashta - King's College LondonS. Lim - Emory UniversityS. Manzi - Allegheny Health NetworkO. Nived - Lund UniversityC. Peschken - University of ManitobaM. Petri - Johns Hopkins UniversityK. Kalunian - University of Illinois at ChicagoA. Rahman - University College LondonR. Ramsey-Goldman - Northwestern UniversityJ. Romero-Diaz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránG. Ruiz-Irastorza - Hospital de CrucesJ. Sanchez-Guerrero - University of TorontoK. Steinsson - Reykjavík UniversityG. Sturfelt - Lund UniversityM. Urowitz - University of TorontoR. Vollenhoven - Karolinska University HospitalD. J. Wallace - University of California, Los AngelesA. Zoma - Hairmyres HospitalJ. Merrill - Oklahoma Medical Research FoundationC. Gordon - University of Birmingham
- Publication Details
- Arthritis care & research (2010), v 70(1), pp 98-103
- Publisher
- Wiley
- Number of pages
- 6
- Grant note
- American College of Rheumatology European League Against Rheumatism
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000418654700011
- Scopus ID
- 2-s2.0-85038126075
- Other Identifier
- 991021934013104721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Rheumatology