Quantitative clinical assessment of disease activity in systemic lupus erythematosus: progress report and research...

Area of Science:

• Rheumatology
• Immunology
• Clinical Medicine

Background:

• Assessing disease activity in multisystem conditions like systemic lupus erythematosus (SLE) lacks a single definitive test.
• Numerous ad hoc scales for SLE disease activity have been developed without rigorous validation.
• Existing measures often fail to capture the full spectrum of SLE manifestations.

Purpose of the Study:

• To evaluate the spectrum of disease activity manifestations in SLE.
• To compare the validity and reliability of different SLE disease activity assessment instruments.
• To highlight the inadequacy of simple criterion summation for measuring SLE activity.

Main Methods:

• Review and comparison of extensively studied SLE disease activity instruments: BILAG, SLEDAI, and SLAM.
• Assessment of convergent and construct validity against clinician's judgment.
• Evaluation of the American Rheumatism Association (ARA) SLE criteria summation as a measure of disease activity.

Main Results:

• The British Isles Lupus Activity Group instrument (BILAG), SLE Disease Activity Index (SLEDAI), and Systemic Lupus Activity Measure (SLAM) have demonstrated convergent and construct validity.
• These validated instruments show greater accuracy compared to clinician's judgment.
• Summation of American Rheumatism Association (ARA) SLE criteria is an inadequate measure of disease activity.

Conclusions:

• Validated instruments like BILAG, SLEDAI, and SLAM are crucial for accurate SLE disease activity assessment.
• Standardized measures enhance the ability to compare research findings across different centers.
• Reliable assessment tools are essential for distinguishing disease activity beyond simple survival outcomes.