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Abstract
Objective The heterogeneous manifestations and clinical course of systemic lupus erythematosus (SLE) challenge disease activity assessment in everyday clinical practice. Multiple clinical disease monitoring instruments have been developed however, they are limited in the ability to detect changes in disease activity or too cumbersome to be utilized in daily practice. In a previous paper case pilot study, we compared the newly constructed ASSESSLE score, with the BILAG and SLEDAI scores and reported good reliability and construct validity. We aimed to apply the ASSESSLE disease activity score in clinical practice and evaluate its validity, and its ability to capture change in disease activity between visits, compared to the BILAG and SLEDAI scores.
Methods The new instrument for assessing SLE activity is comprised of 7 visual analog scales (VAS), which separately address the physician’s global assessment and 6 organ systems including mucocutaneous, musculoskeletal, cardiorespiratory, renal, neuropsychiatric systems, and others. Changes in blood count, serology, and medications are recorded and incorporated into the final score. The study was performed in 2 tertiary medical centers in Israel and included consecutive patients with SLE attending the SLE clinics. Repeated follow-up visits were scored, aiming to assess the score’s ability to detect changes in disease activity between visits.
Results Forty-five SLE patients were scored, 32 of whom had repeated visits (a total of 127 visits). When comparing the 3 scoring tools, the mean trajectories of the first 4 visits (121 of 127 visits) followed a similar trajectory for all 3 scores when looking at global disease activity, as well as activity in the domains most frequently active (mucocutaneous, musculoskeletal and renal domains) (figure 1). The ASSESSLE score correlated well with the BILAG score and with the SLEDAI score (Spearman correlation - 0.71 and 0.69 respectively).
Conclusions The ASSESSLE score shows a good correlation with both the BILAG and the SLEDAI scores and a similar ability to capture change in disease activity over time. The ASSESSLE tool shares the simplicity and ease of interpretation of the SLEDAI and correlates well with the BILAG, allowing its use in everyday practice.
Mean trajectories of the 3 scores of the first 4 visits
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