Chang Erika R, Abrahamowicz Michal, Ferland Diane, Fortin Paul R
The Arthritis Centre of Excellence, Toronto, Ontario, Canada.
J Rheumatol. 2002 Nov;29(11):2350-8.
To determine (1) which organ system manifestations contribute to the overall responsiveness of the Systemic Lupus Activity Measure (SLAM, revised 1991 with minor modifications as SLAM-R) and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI); and (2) whether responsive items differ for physicians and patients.
Blinded data were obtained from repeated visits of 76 patients in the Study of Methotrexate in Lupus Erythematosus. At each visit, physicians and patients reported improvement, no change, or deterioration, and physicians then completed SLAM-R and SLEDAI. Items in SLAM-R and SLEDAI were grouped by organ system. The generalized estimating equations approach was used to measure associations between change in organ system activity and physician or patient perception of change in overall disease activity. The outcomes assessed, in separate analyses, were improvement and deterioration from the previous visit.
Seventy-six patients contributed a total of 471 observations. The strongest correlates of physician-reported improvement were decreased constitutional, gastrointestinal (GI), and musculoskeletal involvement (components of SLAM-R), and decreased musculoskeletal (MSK) and central nervous system involvement (SLEDAI). Improvement reported by patients was most strongly associated with decreases in erythrocyte sedimentation rate and MSK and reticuloendothelial activity (SLAM-R), and in MSK activity (SLEDAI). Increased integument and MSK subscores (SLAM-R) and serosal and MSK subscores (SLEDAI) were associated with overall deterioration reported by physicians. Patient-reported deterioration was associated with increased GI subscores (SLAM-R) and with no changes in organ system involvement in SLEDAI.
Organ systems associated with reported change in overall SLE activity differed between SLAM-R and SLEDAI, between patients and physicians, and between each direction of change.
确定（1）哪些器官系统表现对系统性红斑狼疮活动度测量（SLAM，1991年修订，略作修改后称为SLAM-R）和系统性红斑狼疮疾病活动指数（SLEDAI）的整体反应性有贡献；（2）医生和患者的反应性项目是否存在差异。
从红斑狼疮甲氨蝶呤研究中76例患者的多次访视中获取盲法数据。每次访视时，医生和患者报告病情改善、无变化或恶化情况，然后医生完成SLAM-R和SLEDAI评估。SLAM-R和SLEDAI中的项目按器官系统分组。采用广义估计方程法来测量器官系统活动变化与医生或患者对整体疾病活动变化的感知之间的关联。在单独分析中，评估的结果是与上一次访视相比的改善和恶化情况。
76例患者共提供了471次观察数据。医生报告的病情改善的最强相关因素是全身症状、胃肠道（GI）和肌肉骨骼受累情况减轻（SLAM-R的组成部分），以及肌肉骨骼（MSK）和中枢神经系统受累情况减轻（SLEDAI）。患者报告的病情改善与红细胞沉降率、MSK和网状内皮系统活动度降低（SLAM-R）以及MSK活动度降低（SLEDAI）最为密切相关。皮肤和MSK子评分增加（SLAM-R）以及浆膜和MSK子评分增加（SLEDAI）与医生报告的整体病情恶化相关。患者报告的病情恶化与GI子评分增加（SLAM-R）以及SLEDAI中器官系统受累情况无变化相关。
与系统性红斑狼疮整体活动度报告变化相关的器官系统在SLAM-R和SLEDAI之间、患者和医生之间以及每个变化方向之间均存在差异。
