Study Supports New Instrument for Evaluation of Lupus Disease Activity

A recent study published in the journal Lupus Science & Medicine showed that preliminary results support a new instrument to assess disease activity in systemic lupus erythematous (SLE) patients. The study is entitled “Preliminary test of the LFA rapid evaluation of activity in lupus (LFA-REAL): an efficient outcome measure correlates with validated instruments.”

SLE is a severe autoimmune disease in which the body’s own immune system overreacts and attacks healthy joints and organs. The present SLE disease activity measures are not easily applicable in clinical practice because they are difficult to score and interpret. Several instruments have been developed to monitor lupus disease, namely the SLE Disease Activity Index (SLEDAI), the British Isles Lupus Assessment Group Index (BILAG 2004), and the Safety of Estrogens in Lupus Erythematous National Assessment (SELENA) SLEDAI Physician’s Global Assessment (SS-PGA). However, these measures have a number of weak points, such as the non-differentiation between patients with mild and severe disease and the complexity of the tools so that outcome measures are frequently misunderstood and scored incorrectly.

A new pilot application called Rapid Evaluation of Activity in Lupus (REAL) was developed by the Lupus Foundation of America (LFA) and comprises anchored visual analogue scores (0–100 mm each) for each organ affected by lupus. This new system is predicted to be easy to learn by clinicians and to offer a quick assessment score of lupus patients.

In this study, the use of the LFA-REAL application was assessed regarding the characterization of SLE disease activity. The organ-based LFA-REAL system was compared with the currently most used outcome measures in clinical trials (SLEDAI, BILAG and SS-PGA). 91 individuals with mild to severe SLE disease activity were assessed.

The researchers found that the LFA-REAL had a broader range of scores than the SLEDAI, BILAG or SS-PGA validated instruments, and that this range increased at higher levels of disease activity, indicating that the LFA-REAL has a greater potential to differentiate grades of disease activity among the patients. The total LFA-REAL score correlated with the ones obtained with the other instruments.

The research team concluded that there was a strong correlation between LFA-REAL and lupus disease activity and also with the validated SLE disease activity instruments. Further studies are required to achieve a consistent scoring that can be applied in clinical trials and a reliable instrument to monitor SLE patients in clinical care.