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Original research
Scoring systemic lupus erythematosus (SLE) disease activity with simple, rapid outcome measures
  1. Aikaterini Thanou1,
  2. Judith A James1,2,
  3. Cristina Arriens1,
  4. Teresa Aberle1,
  5. Eliza Chakravarty1,
  6. Joseph Rawdon1,
  7. Stavros Stavrakis2,
  8. Joan T Merrill1 and
  9. Anca Askanase3
  1. 1Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
  2. 2Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  3. 3Department of Rheumatology, Columbia University, New York City, New York, USA
  1. Correspondence to Dr Aikaterini Thanou; Aikaterini-thanou{at}


Objective Existing methods for grading lupus flares or improvement require definition-based thresholds as increments of change. Visual analogue scales (VAS) allow rapid, continuous scaling of disease severity. We analysed the performance of the SELENA SLEDAI Physician’s Global Assessment (SSPGA) and the Lupus Foundation of America-Rapid Evaluation of Activity in Lupus (LFA-REAL) as measures of improvement or worsening in SLE.

Methods We evaluated the agreement between prospectively collected measures of lupus disease activity [SLE Disease Activity Index (SLEDAI), British Isles Lupus Assessment Group Index 2004 (BILAG 2004), Cutaneous Lupus Area and Severity Index (CLASI), SSPGA and LFA-REAL] and response [(SLE Responder Index (SRI)-4 and BILAG-Based Combined Lupus Assessment (BICLA)] in a clinical trial.

Results Fifty patients (47 females, mean age 45 (±11.6) years) were assessed at 528 consecutive visits (average 10.6 (±4.1) visits/patient). Changes in disease activity compared with baseline were examined in 478 visit pairs. SSPGA and LFA-REAL correlated with each other (r=0.936), and with SLEDAI and BILAG (SSPGA: r=0.742 (SLEDAI), r=0.776 (BILAG); LFA-REAL: r=0.778 (SLEDAI), r=0.813 (BILAG); all p<0.0001). Changes (∆) in SSPGA and LFA-REAL compared with screening correlated with each other (r=0.857) and with changes in SLEDAI and BILAG (∆SSPGA: r=0.678 (∆SLEDAI), r=0.624 (∆BILAG); ∆LFA-REAL: r=0.686 (∆SLEDAI) and 0.700 (∆BILAG); all p<0.0001). Changes in SSPGA and LFA-REAL strongly correlated with SRI-4 and BICLA by receiver operating characteristic analysis (p<0.0001 for all). Additionally, LFA-REAL correlated to individual BILAG organ scores (musculoskeletal: r=0.842, mucocutaneous: r=0.826 (p<0.0001 for both)).

Conclusion SSPGA and LFA-REAL are reliable surrogates of common SLE trial end points and could be used as continuous or dichotomous response measures. Additionally, LFA-REAL can provide individualised scoring at the symptom or organ level.

Trial registration number NCT02270957.

  • outcomes research
  • systemic lupus Erythematosus
  • disease activity

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  • JTM and AA are joint senior authors.

  • Contributors AT, CA, TA, EC, JR and JTM were involved in data collection. AT and JTM monitored the data quality. AT, SS and JTM analysed the data. AT, JAJ, JTM and ADA drafted the manuscript. All authors reviewed and edited manuscript and all approved the final manuscript.

  • Funding The study was funded through a research grant by Bristol-Myers Squibb. JAJ has received support from the following grants: U19A082714, P30AR053483 and US4GM10493.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Oklahoma Medical Research Foundation Institutional Review Board and complies with the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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