Columbia University Medical Center, New York, New York.
Brigham and Women's Hospital, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2018 Jul;70(7):1058-1063. doi: 10.1002/acr.23445. Epub 2018 May 21.
Lupus disease measures such as the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the British Isles Lupus Assessment Group (BILAG) index are challenging to interpret. The Lupus Foundation of America-Rapid Evaluation of Activity in Lupus (LFA-REAL) is intended to provide an efficient application of anchored visual analog scores, each representing the individual severity of active symptoms, with the sum of individual scores deriving an overall disease activity assessment. Our objective was to compare the performance of LFA-REAL to systemic lupus erythematosus disease activity assessments and compare scores between trained lupus clinical investigators and clinicians.
Investigators scored the SLEDAI, BILAG, physician's global assessment (PGA), and LFA-REAL, while the clinicians scored the LFA-REAL. The level of agreement between physicians and instruments was determined.
The study included 99 patients (93% women, 31% white, mean ± SD ages 43.4 ± 13.2 years). At the first visit, the mean ± SD SLEDAI score was 5.5 ± 4.5, BILAG score 6.7 ± 7.8, and PGA score 33.6 ± 24.5. The mean ± SD investigator LFA-REAL score was 46.2 ± 42.9, and clinician LFA-REAL score 56.1 ± 53.6. At the second visit, the mean ± SD investigator LFA-REAL score was 41.3 ± 36.7, and clinician LFA-REAL score 48.3 ± 42.6. Total LFA-REAL scores correlated positively with PGA, SLEDAI, and BILAG (ρ = 0.58-0.88, P < 0.001). LFA-REAL scores produced correlation coefficients of ρ > 0.7 for musculoskeletal, mucocutaneous, and renal BILAG domains. The intraclass correlation coefficient between the LFA-REAL scores of investigators and clinicians was 0.79 for visit 1 (P < 0.001) and 0.86 for visit 2 (P < 0.001).
The LFA-REAL provides a reliable surrogate for more complicated disease activity measures when used by lupus clinical investigators or clinicians.
红斑狼疮疾病的衡量标准，如系统性红斑狼疮疾病活动指数（SLEDAI）和不列颠群岛狼疮评估组（BILAG）指数，难以解读。美国狼疮基金会快速评估狼疮活动度（LFA-REAL）旨在提供一种有效的锚定视觉模拟评分的应用，每个评分代表单个活跃症状的严重程度，个体评分的总和得出整体疾病活动度评估。我们的目的是比较 LFA-REAL 与系统性红斑狼疮疾病活动度评估的表现，并比较训练有素的狼疮临床研究者和临床医生之间的评分。
研究者对 SLEDAI、BILAG、医生整体评估（PGA）和 LFA-REAL 进行评分，而临床医生对 LFA-REAL 进行评分。确定医生和仪器之间的一致性程度。
该研究纳入了 99 名患者（93%为女性，31%为白人，平均年龄 ± 标准差为 43.4 ± 13.2 岁）。在第一次就诊时，SLEDAI 评分的平均 ± 标准差为 5.5 ± 4.5，BILAG 评分 6.7 ± 7.8，PGA 评分为 33.6 ± 24.5。研究者 LFA-REAL 评分的平均 ± 标准差为 46.2 ± 42.9，临床医生 LFA-REAL 评分为 56.1 ± 53.6。第二次就诊时，研究者 LFA-REAL 评分的平均 ± 标准差为 41.3 ± 36.7，临床医生 LFA-REAL 评分为 48.3 ± 42.6。总 LFA-REAL 评分与 PGA、SLEDAI 和 BILAG 呈正相关（ρ=0.58-0.88，P<0.001）。LFA-REAL 评分与肌肉骨骼、黏膜皮肤和肾脏 BILAG 域的相关系数 ρ>0.7。研究者和临床医生的 LFA-REAL 评分的组内相关系数在第一次就诊时为 0.79（P<0.001），第二次就诊时为 0.86（P<0.001）。
当由狼疮临床研究者或临床医生使用时，LFA-REAL 为更复杂的疾病活动度衡量标准提供了可靠的替代方法。
