1. Study of Flare Assessment in Systemic Lupus Erythematosus Based on Paper Patients
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1 UCL, London, England Show more 2 Hosp Trop Dis, London, England Show more 3 Feinstein Inst Med Res, Manhasset, NY USA Show more 4 Columbia Univ, New York, NY USA Show more 5 Hanyang Univ Hosp Rheumat Dis, Seoul, South Korea Show more 6 McGill Univ, Quebec City, PQ, Canada Show more 7 Univ Manchester, Cent Manchester Univ Hosp NHS Fdn Trust, Manchester, Lancs, England Show more 8 Manchester Acad Hlth Sci Ctr, Manchester, Lancs, England 9 New York Sch Med, New York, NY USA Show more 10 Univ Barcelona, Barcelona, Spain Show more 11 Univ Calgary, Cumming Sch Med, Calgary, AB, Canada Show more 12 Univ N Carolina, Chapel Hill, NC USA Show more 13 Univ Laval, Quebec City, PQ, Canada 14 Downstate Med Ctr Rheumatol, Brooklyn, NY USA Show more 15 Toronto Western Hosp, Krembil Res Inst, Toronto, ON, Canada Show more 16 Univ Toronto, Toronto, ON, Canada Show more 17 Nova Scotia Rehabil Ctr, Halifax, NS, Canada Show more 18 Istanbul Univ, Istanbul, Turkey Show more 19 Rigshosp, Copenhagen, Denmark 20 Med Univ South Carolina, Charleston, SC USA Show more 21 Kings Coll London, London, England Show more 22 Emory Univ, Atlanta, GA 30322 USA 23 Allegheny Hlth Network, Pittsburgh, PA USA Show more 24 Lund Univ, Lund, Sweden Show more 25 Univ Manitoba, Winnipeg, MB, Canada Show more 26 Johns Hopkins Univ, Baltimore, MD USA Show more 27 Univ Calif San Diego, San Diego, CA 92103 USA Show more 28 Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA Show more 29 Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico City, DF, Mexico 30 Hosp Univ Cruces & Univ Basque Country, Baracaldo, Spain Show more 31 Mt Sinai Hosp, Toronto, ON, Canada Show more 32 Univ Hlth Network, Toronto, ON, Canada Show more 33 Univ Toronto, Toronto, ON, Canada Show more 34 Landspitali Univ Hosp, Reykjavik, Iceland Show more 35 Karolinska Univ Hosp, Solna, Sweden Show mor, University College London; London UK, The Hospital For Tropical Diseases; London UK, Feinstein Institute for Medical Research; Manhasset New York, Columbia University; New York New York, Hanyang University Hospital for Rheumatic Diseases; Seoul South Korea, McGill University; Quebec Ontario Canada, The University of Manchester; Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre; Manchester UK, New York School of Medicine; New York, Universitat de Barcelona; Barcelona Spain, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada, University of North Carolina; Chapel Hill, Université Laval; Quebec City Québec Canada, Downstate Medical Center Rheumatology; Brooklyn New York, Krembil Research Institute; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada, Nova Scotia Rehabiliation Center; Halifax Nova Scotia Canada, Istanbul University; Istanbul Turkey, Rigshospitalet; Copenhagen Denmark, Medical University of South Carolina; Charleston UK, King's College London; London UK, Emory University; Atlanta Georgia, Allegheny Health Network; Pittsburgh Pennsylvania, Lund University; Lund Sweden, University of Manitoba; Winnipeg Manitoba Canada, Johns Hopkins University; Baltimore Maryland, University of California at San Diego; Chicago Illinois, Northwestern University; Feinberg School of Medicine; Chicago Illinois, Instituto Nacional de Ciencias Médicas y Nutrición; Mexico City Mexico, Hospital Universitario Cruces and University of the Basque Country; Barakaldo Spain, Mount Sinai Hospital and University Health Network and University of Toronto; Toronto Ontario Canada, Landspitali University Hospital; Reykjavik Iceland, Karolinska University Hospital; Solna Sweden, University of California at Los Angeles; Scotland UK, Hairmyres Hospital; East Kilbride Scotland UK, Oklahoma Medical Research Foundation; Oklahoma City UK, College of Medical and Dental Sciences; University of Birmingham; Birmingham UK, Isenberg, D., Sturgess, J., Allen, E., Aranow, C., Askanase, A., Sang-Cheol, B., Bernatsky, S., Bruce, I., Buyon, J., Cervera, R., Clarke, A., Dooley, Mary Anne, Fortin, P., Ginzler, E., Gladman, D., Hanly, J., Inanc, M., Jacobsen, S., Kamen, D., Khamashta, M., Lim, S., Manzi, S., Nived, O., Peschken, C., Petri, M., Kalunian, K., Rahman, A., Ramsey-Goldman, R., Romero-Diaz, J., Ruiz-Irastorza, G., Sanchez-Guerrero, J., Steinsson, K., Sturfelt, G., Urowitz, M., Van Vollenhoven, R., Wallace, D.J., Zoma, A., Merrill, J., Gordon, C., 1 UCL, London, England Show more 2 Hosp Trop Dis, London, England Show more 3 Feinstein Inst Med Res, Manhasset, NY USA Show more 4 Columbia Univ, New York, NY USA Show more 5 Hanyang Univ Hosp Rheumat Dis, Seoul, South Korea Show more 6 McGill Univ, Quebec City, PQ, Canada Show more 7 Univ Manchester, Cent Manchester Univ Hosp NHS Fdn Trust, Manchester, Lancs, England Show more 8 Manchester Acad Hlth Sci Ctr, Manchester, Lancs, England 9 New York Sch Med, New York, NY USA Show more 10 Univ Barcelona, Barcelona, Spain Show more 11 Univ Calgary, Cumming Sch Med, Calgary, AB, Canada Show more 12 Univ N Carolina, Chapel Hill, NC USA Show more 13 Univ Laval, Quebec City, PQ, Canada 14 Downstate Med Ctr Rheumatol, Brooklyn, NY USA Show more 15 Toronto Western Hosp, Krembil Res Inst, Toronto, ON, Canada Show more 16 Univ Toronto, Toronto, ON, Canada Show more 17 Nova Scotia Rehabil Ctr, Halifax, NS, Canada Show more 18 Istanbul Univ, Istanbul, Turkey Show more 19 Rigshosp, Copenhagen, Denmark 20 Med Univ South Carolina, Charleston, SC USA Show more 21 Kings Coll London, London, England Show more 22 Emory Univ, Atlanta, GA 30322 USA 23 Allegheny Hlth Network, Pittsburgh, PA USA Show more 24 Lund Univ, Lund, Sweden Show more 25 Univ Manitoba, Winnipeg, MB, Canada Show more 26 Johns Hopkins Univ, Baltimore, MD USA Show more 27 Univ Calif San Diego, San Diego, CA 92103 USA Show more 28 Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA Show more 29 Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico City, DF, Mexico 30 Hosp Univ Cruces & Univ Basque Country, Baracaldo, Spain Show more 31 Mt Sinai Hosp, Toronto, ON, Canada Show more 32 Univ Hlth Network, Toronto, ON, Canada Show more 33 Univ Toronto, Toronto, ON, Canada Show more 34 Landspitali Univ Hosp, Reykjavik, Iceland Show more 35 Karolinska Univ Hosp, Solna, Sweden Show mor, University College London; London UK, The Hospital For Tropical Diseases; London UK, Feinstein Institute for Medical Research; Manhasset New York, Columbia University; New York New York, Hanyang University Hospital for Rheumatic Diseases; Seoul South Korea, McGill University; Quebec Ontario Canada, The University of Manchester; Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre; Manchester UK, New York School of Medicine; New York, Universitat de Barcelona; Barcelona Spain, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada, University of North Carolina; Chapel Hill, Université Laval; Quebec City Québec Canada, Downstate Medical Center Rheumatology; Brooklyn New York, Krembil Research Institute; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada, Nova Scotia Rehabiliation Center; Halifax Nova Scotia Canada, Istanbul University; Istanbul Turkey, Rigshospitalet; Copenhagen Denmark, Medical University of South Carolina; Charleston UK, King's College London; London UK, Emory University; Atlanta Georgia, Allegheny Health Network; Pittsburgh Pennsylvania, Lund University; Lund Sweden, University of Manitoba; Winnipeg Manitoba Canada, Johns Hopkins University; Baltimore Maryland, University of California at San Diego; Chicago Illinois, Northwestern University; Feinberg School of Medicine; Chicago Illinois, Instituto Nacional de Ciencias Médicas y Nutrición; Mexico City Mexico, Hospital Universitario Cruces and University of the Basque Country; Barakaldo Spain, Mount Sinai Hospital and University Health Network and University of Toronto; Toronto Ontario Canada, Landspitali University Hospital; Reykjavik Iceland, Karolinska University Hospital; Solna Sweden, University of California at Los Angeles; Scotland UK, Hairmyres Hospital; East Kilbride Scotland UK, Oklahoma Medical Research Foundation; Oklahoma City UK, College of Medical and Dental Sciences; University of Birmingham; Birmingham UK, Isenberg, D., Sturgess, J., Allen, E., Aranow, C., Askanase, A., Sang-Cheol, B., Bernatsky, S., Bruce, I., Buyon, J., Cervera, R., Clarke, A., Dooley, Mary Anne, Fortin, P., Ginzler, E., Gladman, D., Hanly, J., Inanc, M., Jacobsen, S., Kamen, D., Khamashta, M., Lim, S., Manzi, S., Nived, O., Peschken, C., Petri, M., Kalunian, K., Rahman, A., Ramsey-Goldman, R., Romero-Diaz, J., Ruiz-Irastorza, G., Sanchez-Guerrero, J., Steinsson, K., Sturfelt, G., Urowitz, M., Van Vollenhoven, R., Wallace, D.J., Zoma, A., Merrill, J., and Gordon, C.
- Abstract
To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files, OBJECTIVE: To determine the level of agreement of disease flare severity (distinguishing severe, moderate, and mild flare and persistent disease activity) in a large paper-patient exercise involving 988 individual cases of systemic lupus erythematosus. METHODS: A total of 988 individual lupus case histories were assessed by 3 individual physicians. Complete agreement about the degree of flare (or persistent disease activity) was obtained in 451 cases (46%), and these provided the reference standard for the second part of the study. This component used 3 flare activity instruments (the British Isles Lupus Assessment Group [BILAG] 2004, Safety of Estrogens in Lupus Erythematosus National Assessment [SELENA] flare index [SFI] and the revised SELENA flare index [rSFI]). The 451 patient case histories were distributed to 18 pairs of physicians, carefully randomized in a manner designed to ensure a fair case mix and equal distribution of flare according to severity. RESULTS: The 3-physician assessment of flare matched the level of flare using the 3 indices, with 67% for BILAG 2004, 72% for SFI, and 70% for rSFI. The corresponding weighted kappa coefficients for each instrument were 0.82, 0.59, and 0.74, respectively. We undertook a detailed analysis of the discrepant cases and several factors emerged, including a tendency to score moderate flares as severe and persistent activity as flare, especially when the SFI and rSFI instruments were used. Overscoring was also driven by scoring treatment change as flare, even if there were no new or worsening clinical features. CONCLUSION: Given the complexity of assessing lupus flare, we were encouraged by the overall results reported. However, the problem of capturing lupus flare accurately is not completely solved.