title: Preliminary test of the LFA rapid evaluation of activity in lupus (LFA-REAL): an efficient outcome measure correlates with validated instruments.
abstract: OBJECTIVE
  Current disease activity measures for systemic lupus erythematosus (SLE) are difficult to score or interpret and problematic for use in clinical practice. Lupus Foundation of America (LFA)-Rapid Evaluation of Activity in Lupus (REAL) is a pilot application composed of anchored visual analogue scores (0-100 mm each) for each organ affected by lupus. This study evaluated the use of LFA-REAL in capturing SLE disease activity.
  
  
  METHODS
  In a preliminary test of LFA-REAL, this simplified, organ-based system was compared with the most widely used outcome measures in clinical trials, the British Isles Lupus Assessment Group 2004 Index (BILAG), the SLE Disease Activity Index (SLEDAI) and the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) SLEDAI Physician's Global Assessment (SS-PGA). The level of agreement was analysed using Spearman rank correlations.
  
  
  RESULTS
  91 patients with SLE with mild to severe disease activity were evaluated, their median SLEDAI score was 4.0 (range 0-28) and BILAG score 8.0 (0-32). The median SS-PGA was 38 mm (4-92) versus the total REAL 50 mm (0-268), which expands in range by additive organ scores. Thirty-three patients had moderate to severe disease activity (≥1.5 on SS-PGA landmarks). The median SS-PGA score of this group was 66 mm (50-92) versus median REAL score of 100 mm (59-268), confirming ability to detect a wider distribution of scores at higher disease activity. Total REAL correlated with SLEDAI, BILAG and SS-PGA (correlation coefficient=0.816, 0.933 and 0.903, respectively; p<0.001 for all). Individual LFA-REAL organ scores for musculoskeletal and mucocutaneous also correlated with corresponding BILAG domain scores (correlation coefficient=0.925 and 0.934, p<0.001).
  
  
  CONCLUSIONS
  In this preliminary exercise, there were strong correlations between LFA-REAL and validated lupus disease activity indices. Further development may be valuable for consistent scoring in clinical trials, grading optimal assessment of change in disease activity and reliable monitoring of patients in practice.
authors: Department of Medicine , Columbia University Medical Center , New York, New York , USA.
authors: Anca
authors: A
authors: Askanase
authors: Department of Medicine , Columbia University Medical Center , New York, New York , USA.
authors: Xiaoqing
authors: X
authors: Li
authors: Department of Medicine , Columbia University Medical Center , New York, New York , USA.
authors: Avery
authors: A
authors: Pong
authors: Department of Medicine , Columbia University Medical Center , New York, New York , USA.
authors: Katrina
authors: K
authors: Shum
authors: Clinical Pharmacology Research Program , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA.
authors: Stan
authors: S
authors: Kamp
authors: Clinical Pharmacology Research Program , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA.
authors: Fredonna
authors: F
authors: Carthen
authors: Clinical Pharmacology Research Program , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA.
authors: Teresa
authors: T
authors: Aberle
authors: Lupus Foundation of America , Washington DC , USA.
authors: Leslie
authors: L
authors: Hanrahan
authors: Lupus Foundation of America , Washington DC , USA.
authors: Paola
authors: P
authors: Daly
authors: Department of Medicine , Columbia University Medical Center , New York, New York , USA.
authors: Jon
authors: J
authors: Giles
authors: Clinical Pharmacology Research Program , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA.
authors: Joan T
authors: JT
authors: Merrill
keywords: Autoantibodies; Autoimmune Diseases; Systemic Lupus Erythematosus