New Tools to Measure Disease Activity in SLE

December 4, 2013

ACR2013: Well adapted to electronic formats, the new Lupus Activity Scoring Tool stands up well to other disease activity indices. Also, an online toolkit of validated lupus assessment tools.

Assessing disease activity in rheumatic diseases such as systemic lupus erythematosus (SLE) is vital for effective treatment. A new tool -- the Lupus Activity Scoring Tool (LAST) – has been proposed to join the ranks of current disease activity indices.

A validation study comparing the LAST to the SELENA SLEDAI (SS) using assessments for 31 patients from four Canadian clinics found it was highly sensitive and correlated well with SS scores obtained at the clinics, researchers told the recent 2013 annual meeting of the American College of Rheumatology in San Diego.

The multicenter study also found electronic web-based versions of the LAST developed for iPad and Windows were simpler and more error-free than manually-obtained scores, reported Majed Khraishi MD, medical director of rheumatology at Nexus Clinical Research at the Memorial University of Newfoundland.

“Our study validated the LAST tool in different clinical settings with different assessors. The electronic apps were not only easier to use but just as accurate, so they could potentially be used in non-specialist settings,” Khraishi commented in an interview.
 
LAST includes five simple clinical variables -- patient global assessment of disease activity (PGA), physician global assessment of disease activity (PHGA), C3, C4, and Anti-ds Anti-DNA titer abnormalities -- plus a formula incorporating the current immunomodulating medication.

Ninety percent of the study patients were women (mean age 46.3) with mean disease duration of 13.6 years. They were evaluated with both LAST and the SS at each visit, and those with multiple assessments were followed to compare the disease activity scores obtained with each tool. In all, investigators obtained 68 assessments.

The mean SLEDAI score was 6.6 and the mean LAST score (incorporating C3, C4 and Anti-ds Anti-DNA) was 34.9. SLEDAI scores strongly correlated with LAST scores at baseline and follow-up visits, with SS scores of 0-4 corresponding to LAST scores of 0-30, and SS scores of 8 or higher paralleling LAST scores of 50 and higher.

Finding a Toolbox for SLE

A second poster presented at the ACR meeting reported on a multi-national effort to develop an online “Toolbox” -- a database of validated patient-reported outcomes (PROs) instruments – using SLE as an example.

The project involved researchers in the US, Spain, Denmark, Norway, Switzerland, France, and the EULAR Standing Committee of People with Arthritis/Rheumatism in Europe.

The team conducted a literature review using SLE as a target disease and found 10 validated tools that assess the domains of disease activity, quality of life, patient needs, symptoms, organ and joint damage,
health outcomes, and family functioning.

The preliminary PROSs toolbox contains:

•    SLAQ (Systemic Lupus Activity Quesionnaire)
•    SLEQoL (SLE Symptom Checklist)
•    SLEQQL (SLE-specific quality of life instrument)
•    LupusQoL (Lupus Quality of Life)
•    SLENQ (SLE Needs Questionnaire)
•    LDIQ, (Lupus Damage Index Quentionnaire)
•    BILD (Brief Index of Lupus Damage)
•    LupusPRO (Lupus Patient-Reported Outcomes)
•    SLE-FAMILY (family functioning)

The PROs online Toolbox, which includes recommendations for use and translated versions, is available at http://oml.eular.org/ .