A Rapid Evaluation of Activity in Lupus (LFA-REAL™) Correlates with More Complex Disease Activity Instruments Whether Evaluated by Clinical Investigators or Real-World Clinicians

5 years ago

A Rapid Evaluation of Activity in Lupus (LFA-REAL™) Correlates with More Complex Disease Activity Instruments Whether Evaluated by Clinical Investigators or Real-World Clinicians

Aikaterini Thanou-Stavraki, Diane Kamen, S Sam Lim, Karen Costenbader, Samantha C Nguyen, Mimi Kim, Cynthia Aranow, Leslie M Hanrahan, DeAnna Baker-Frost, Joan T Merrill, Teja M Kapoor, Jennifer Grossman, Anca D Askanase, Teresa Aberle

Lupus disease measures such as the SLE Disease Activity Index (SLEDAI) and the British Isles Lupus Assessment Group (BILAG) Index are challenging to interpret. The Lupus Foundation of America–Rapid Evaluation of Activity in Lupus (LFA-REAL) is intended to provide an efficient application of anchored visual analogue scores, each representing the individual severity of active symptoms, with the sum of individual scores deriving an overall disease activity assessment. Objectives To compare the performance of LFA-REAL to SLE disease activity assessments and compare scores between trained lupus clinical investigators and clinicians. Methods Investigators scored the SLEDAI, BILAG, PGA, and LFA-REAL, while the clinicians scored the LFA-REAL. The level of agreement between physicians and instruments was determined. Results The study included 99 patients, 93% women, 31% Caucasian, 43.4 (±13.2) years old. At the first visit, the SLEDAI was 5.5 (±4.5), BILAG 6.7 (±7.8), and PGA 33.6 (±24.5). The investigator REAL was 46.2 (±42.9), and clinician REAL 56.1 (±53.6). At the second visit, the investigator REAL was 41.3 (±36.7), and clinician REAL 48.3 (±42.6). Total REAL scores correlated positively with PGA, SLEDAI, and BILAG (ρ 0.58-0.88, p <0.001). REAL scores produced correlation coefficients ρ > 0.7 for musculoskeletal, mucocutaneous, and renal BILAG domains. The intra-class correlation coefficient between the REAL scores of investigators and clinicians was 0.79 for Visit1 (p < 0.001) and 0.86 for Visit2 (p < 0.001). Conclusion The LFA-REAL provides a reliable surrogate for more complicated disease activity measures when used by lupus clinical investigators or clinicians. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/acr.23445