American College of Rheumatology Provisional Criteria for Global Flares in Childhood-Onset Systemic Lupus Erythematosus

Author(s):Show less -

Brunner, Hermine I. ^{[1, 2]} ; Holland, Michael ^{[1, 2]} ; Beresford, Michael W. ^[3] ; Ardoin, Stacy P. ^{[4, 5]} ; Appenzeller, Simone ^[6] ; Silva, Clovis A. ^[7] ; Flores, Francisco ^{[1, 2]} ; Goilav, Beatrice ^[8] ; Wenderfer, Scott E. ^{[9, 10]} ; Levy, Deborah M. ^{[11, 12]} ; Ravelli, Angelo ^{[13, 14]} ; Khunchandani, Raju ^[15] ; Avcin, Tadej ^[16] ; Klein-Gitelman, Marisa S. ^{[17, 18]} ; Feldman, Brian M. ; Ruperto, Nicolino ^{[13, 14]} ; Ying, Jun ^[2] ; INVESTIGATORS, PRCSG PRINTO

Affiliation:Show less -

^[1] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 - USA

^[2] Univ Cincinnati, Cincinnati, OH - USA

^[3] Inst Translat Med, Liverpool, Merseyside - England

^[4] Ohio State Univ, Nationwide Childrens Hosp, Columbus, OH 43210 - USA

^[5] Wexner Med Ctr, Columbus, OH - USA

^[6] Univ Estadual Campinas, Campinas, SP - Brazil

^[7] Univ Sao Paulo, Hosp Clin HCFMUSP, Childrens Inst, Sao Paulo - Brazil

^[8] Childrens Hosp Montefiore, Albert Einstein Coll Med, Bronx, NY - USA

^[9] Texas Childrens Hosp, Houston, TX 77030 - USA

^[10] Baylor Coll Med, Houston, TX 77030 - USA

^[11] Univ Toronto, Toronto, ON - Canada

^[12] Hosp Sick Children, Toronto, ON - Canada

^[13] Univ Genoa, Genoa - Italy

^[14] Ist Giannina Gaslini, Clin Pediat & Reumatol, Genoa - Italy

^[15] Jaslok Hosp, Bombay, Maharashtra - India

^[16] Univ Med Ctr, Univ Childrens Hosp, Ljubljana - Slovenia

^[17] Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 - USA

^[18] Ann & Robert Lurie Childrens Hosp, Chicago, IL - USA

• Document type: Journal article
• Source: ARTHRITIS CARE & RESEARCH; v. 70, n. 6, p. 813-822, JUN 2018.
• Web of Science Citations: 4

Abstract

Objective. To validate the preliminary criteria of global flare for childhood-onset SLE (cSLE). Methods. Pediatricians experienced in cSLE care (n = 268) rated unique patient profiles; results of standard cSLE laboratory testing and information about the cSLE flare descriptors were presented as follows: global assessment of patient well-being, physician global assessment of disease activity (MD-global), Disease Activity Index score, protein/creatinine ratio (PCR), and erythrocyte sedimentation rate (ESR). Using rater interpretation of the course of cSLE (baseline versus followup as the gold standard), performance (sensitivity, specificity, area under the receiver operating characteristic curve {[}AUC]) of the preliminary flare criteria was tested. An international consensus conference was held to rank the preliminary flare criteria as per the American College of Rheumatology recommendations and delineate threshold scores for minor, moderate, and major flares. Results. The accuracy of the 2 highest-ranked candidate criteria that consider absolute changes (Delta) of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) or British Isles Lupus Assessment Group (BILAG) (numeric scoring: A = 12, B = 8, C = 1, and D/E = 0), MD-global, PCR, and ESR were confirmed (both AUC >0.93). For the SLEDAI-based criteria (0.5 x Delta SLEDAI + 0.45 x Delta PCR + 0.5 x Delta MD-global + 0.02 x Delta ESR) flare scores >= 6.4/3.0/0.6 constituted major/moderate/minor flares, respectively. For the BILAG-based algorithm (0.4 x Delta BILAG + 0.65 x Delta PCR + 0.5 x Delta MD-global + 0.02 x Delta ESR) flare scores >= 7.4/3.7/2.2 delineated major/moderator/minor flares, respectively. These threshold values (SLEDAI, BILAG) were all >82% sensitive and specific for capturing flare severity. Conclusion. Provisional criteria for global flares in cSLE are available to identify patients who experienced a flare. These criteria also allow for discrimination of the severity of cSLE exacerbations. (AU)

• FAPESP's process: 15/03756-4 - Assessment of relevance of blood levels of drugs in the monitoring rheumatic autoimmune diseases: safety, effectiveness and adherence to therapy
• Grantee: Eloisa Silva Dutra de Oliveira Bonfá
• Support Opportunities: Research Projects - Thematic Grants