Premium
Preliminary criteria for global flares in childhood‐onset systemic lupus erythematosus
Author(s) -
Brunner Hermine I.,
Mina Rina,
Pilkington Clarissa,
Beresford Michael W.,
Reiff Andreas,
Levy Deborah M.,
Tucker Lori B.,
Eberhard B. Anne,
Ravelli Angelo,
Schanberg Laura E.,
SaadMagalhaes Claudia,
Higgins Gloria C.,
Onel Karen,
Singer Nora G.,
von Scheven Emily,
Itert Lukasz,
KleinGitelman Marisa S.,
Punaro Marilynn,
Ying Jun,
Giannini Edward H.
Publication year - 2011
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.20507
Subject(s) - medicine , erythrocyte sedimentation rate , rheumatology , flare , systemic lupus erythematosus , receiver operating characteristic , severity of illness , disease , astrophysics , physics
Objective To develop widely acceptable preliminary criteria of global flare for childhood‐onset systemic lupus erythematosus (cSLE). Methods Pediatric rheumatologists (n = 138) rated a total of 358 unique patient profiles with information about the cSLE flare descriptors from 2 consecutive visits: patient global assessment of well‐being, physician global assessment of disease activity (MD‐global), health‐related quality of life, anti–double‐stranded DNA antibodies, disease activity index scores, protein:creatinine (P:C) ratio, complement levels, and erythrocyte sedimentation rate (ESR). Based on 2,996 rater responses about the course of cSLE (baseline versus followup), the accuracy (sensitivity, specificity, and area under the receiver operating characteristic curve) of candidate flare criteria was assessed. An international consensus conference was held to rank these candidate flare criteria as per the American College of Rheumatology recommendations for the development and validation of criteria sets. Results The highest‐ranked candidate criteria considered absolute changes (Δ) of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) or British Isles Lupus Assessment Group (BILAG), MD‐global, P:C ratio, and ESR; flare scores can be calculated (0.5 × ΔSLEDAI + 0.45 × ΔP:C ratio + 0.5 × ΔMD‐global + 0.02 × ΔESR), where values of ≥1.04 are reflective of a flare. Similarly, BILAG‐based flare scores (0.4 × ΔBILAG + 0.65 × ΔP:C ratio + 0.5 × ΔMD‐global + 0.02 × ΔESR) of ≥1.15 were diagnostic of a flare. Flare scores increased with flare severity. Conclusion Consensus has been reached on preliminary criteria for global flares in cSLE. Further validation studies are needed to confirm the usefulness of the cSLE flare criteria in research and for clinical care.