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Do lupus disease activity measures detect clinically important change?

P R Fortin1, M Abrahamowicz, A E Clarke

  • 1McGill University Health Center, Department of Medicine, Montreal General Hospital Research Institute, Quebec, Canada. paul.fortin@uhn.on.ca

The Journal of Rheumatology
|June 14, 2000
PubMed
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The revised Systemic Lupus Activity Measure (SLAM-R) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) are responsive in tracking lupus activity. SLAM-R demonstrates greater responsiveness than SLEDAI for clinical assessment.

Area of Science:

  • Rheumatology
  • Clinical Immunology
  • Medical Statistics

Background:

  • Systemic lupus erythematosus (SLE) requires reliable measures for assessing disease activity.
  • Standardized multi-item instruments are crucial for quantifying SLE progression and treatment efficacy.
  • The revised Systemic Lupus Activity Measure (SLAM-R) and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) are widely used in clinical practice.

Purpose of the Study:

  • To evaluate the responsiveness of SLAM-R and SLEDAI to changes in disease activity in SLE patients.
  • To compare the ability of SLAM-R and SLEDAI to detect clinically relevant changes in lupus activity.
  • To assess the validity and reliability of these instruments in a clinical setting.

Main Methods:

  • Ninety-six patients with definite SLE were enrolled.

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  • Disease activity was assessed monthly using SLAM-R and SLEDAI over five months.
  • Responsiveness was evaluated using five distinct statistical methods, including effect size, standardized response mean, and ROC curve analysis.

    • Main Results:

    • Both SLAM-R and SLEDAI demonstrated responsiveness to changes in SLE disease activity.
    • SLAM-R consistently showed moderate, but superior, responsiveness compared to SLEDAI.
    • All five analytical methods confirmed a consistent ranking of the disease activity measures.

    Conclusions:

    • SLAM-R and SLEDAI are validated, responsive instruments for monitoring SLE activity.
    • SLAM-R is a more responsive measure than SLEDAI for assessing clinical changes in lupus patients.
    • These findings support the use of SLAM-R for more sensitive detection of disease activity fluctuations.