SLEDAI-2K Does Not Conceal Worsening in a Particular System When There Is Overall Improvement

Zahi Touma; Dafna D Gladman; Jiandong Su; Dominique Ibañez; Murray B Urowitz

doi:10.3899/jrheum.141088

SLEDAI-2K Does Not Conceal Worsening in a Particular System When There Is Overall Improvement

J Rheumatol. 2015 Aug;42(8):1401-5. doi: 10.3899/jrheum.141088. Epub 2015 Jun 15.

Authors

Zahi Touma¹, Dafna D Gladman¹, Jiandong Su¹, Dominique Ibañez¹, Murray B Urowitz²

Affiliations

¹ From the University of Toronto, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Research Institute, Toronto, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Assistant Professor of Medicine, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Co-director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto; J. Su, MB, BSc; D. Ibañez, MSc, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital.
² From the University of Toronto, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Research Institute, Toronto, Ontario, Canada.Z. Touma, MD, FACP, FACR, PhD, Assistant Professor of Medicine, University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Co-director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto; J. Su, MB, BSc; D. Ibañez, MSc, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Toronto Western Research Institute, and Director, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital. m.urowitz@utoronto.ca.

PMID: 26077403
DOI: 10.3899/jrheum.141088

Abstract

Objective: To determine whether the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) is valid in identifying patients who had a clinically important overall improvement with no worsening in other descriptors/systems.

Methods: Consecutive patients with systemic lupus erythematosus with active disease who attended the Lupus Clinic between 2000 and 2012 were studied. Based on the change in the total SLEDAI-2K scores on last visit, patients were grouped as improved, flared/worsened, and unchanged. Patients showing improvement were evaluated for the presence of new active descriptors at last visit compared with baseline visit.

Results: Of the 158 patients studied, 109 patients had improved, 38 remained unchanged, and 11 flared/worsened at last visit. In the improved group, 11 patients had a new laboratory descriptor that was not present at baseline visit. In those 11 patients, this new laboratory descriptor was not clinically significant and did not require a change in disease management.

Conclusion: The SLEDAI-2K identifies improvement in disease activity overall without concealing clinically important worsening.

Keywords: DISEASE ACTIVITY; SLEDAI-2K; SYSTEMIC LUPUS ERYTHEMATOSUS.

MeSH terms

Adolescent
Adult
Disease Progression
Female
Humans
Lupus Erythematosus, Systemic / diagnosis*
Male
Middle Aged
Severity of Illness Index
Symptom Assessment
Young Adult