Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Discordance between Self-Report and Physician-Assessed Disease Activity in Patients with Systemic Lupus Erythematosus (SLE): Implications for Clinical Trial Design and Clinical Care.

Askanase3,  Anca D., Castrejon4,  Isabel, Buyon5,  Jill P., Yazici1,  Yusuf, Pincus2,  Theodore

Hospital for Joint Diseases, Hastings on Hudson, NY
New York University Hospital for Joint Disease, Hastings-on-Hudson, NY
NYU Hospital for Joint Diseases, New York, NY
NYU Hospital for Joint Diseases
NYU School of Medicine, New York, NY

Purpose:

To analyze agreement levels between patient (PT) and physician (MD) assessments in 50 patients with SLE seen in usual care, including a) global PT and MD estimates of status; b) patient self-report scores on the SLAQ (Systemic Lupus Activity Questionnaire) and MDHAQ (Multidimensional Health Assessment Questionnaire) for physical function (FN), pain (PN), patient global estimate (PTGL), fatigue (FT), RAPID3 (FN, PN, and PTGL), and review of systems checklist (SX); c) physician-scored indices SLEDAI-2K (SLE Disease Activity Index), BILAG (British Isles Lupus Assessment Group index), SLAM (SLE Activity Measure) and ECLAM (European Consensus Lupus Activity Measurement).

Methods:

A cross-sectional study was performed in 50 consecutive SLE patients of one rheumatologist. Patients completed the SLAQ and MDHAQ, including PTGL. The rheumatologist scored a physician global estimate (MDGL) (scored 0–3 in 0.1 increments) without knowledge of PTGL, and completed the SLEDAI 2K, BILAG, SLAM, and ECLAM. Agreement levels of various measures were analyzed using Spearman rank order correlations.

Results:

The study included 45 women and 5 men, mean age 38.7 years, mean disease duration 7.3 years, 36% Caucasian, 18% Black, 26% Hispanic, 18% Asian. The mean MDGL (1.10±0.62), PTGL (3.11 ±2.81) and SLE indices (SLEDAI 5.02±3.75; BILAG 4.60±4.31; SLAM 3.86±2.92; ECLAM 1.97±1.37) indicated mild/moderate lupus activity. The correlation between MDGL and PTGL of rho=0.14 was not statistically significant. Correlations between MDGL and SLE indices were significant, rho=0.60–0.72 (p<0.001). Correlations between PTGL and patient measures also were significant, rho=0.58–0.87 (p<0.001). However, PTGL was correlated at lower levels with SLE indices – significantly with BILAG and SLAM (0.35–0.40; p<0.01), and not significantly with SLEDAI or ECLAM. MDGL was not correlated significantly with any patient measure or index.

  PTGLMDGL
Patient MeasuresSLAQ  
 • Total score0.60*-0.08
 • # positives0.58*-0.06
 • VAS activity0.69*0.34
 MDHAQ  
 • FN0.68*0.08
 • PN0.87*0.08
 • FT0.79*-0.02
 • PTGL-0.14
 • # SX0.66*0.03
Physician MeasuresMDGL0.14-
 SLEDAI0.160.72*
 BILAG0.35†0.70*
 SLAM0.40*0.64*
 ECLAM0.260.60*
*p<0.0001;
†p<0.01

Conclusion:

MDGL and PTGL are not correlated significantly, an observation made previously. MDGL was correlated significantly with all physician-derived indices, and PTGL was correlated significantly with all patient-derived measures and indices. By contrast, MDGL was correlated at much lower, non-significant levels with patient-derived measures and indices, and PTGL was correlated at lower levels with physician-derived indices. Further analysis of these discordances may clarify the clinical relevance of various measures in clinical trials, and may lead to improved care and compliance in patients with SLE.

To cite this abstract, please use the following information:
Askanase, Anca D., Castrejon, Isabel, Buyon, Jill P., Yazici, Yusuf, Pincus, Theodore; Discordance between Self-Report and Physician-Assessed Disease Activity in Patients with Systemic Lupus Erythematosus (SLE): Implications for Clinical Trial Design and Clinical Care. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1857
DOI: 10.1002/art.29622

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