1Assessment of patients with systemic lupus erythematosus and the use of lupus disease activity indices
Section snippets
What should physicians assess, and why?
Most physicians are aware of the 11 revised classification criteria for SLE of the American College of Rheumatology (ACR).1 (Table 1) A patient has to have four or more of these criteria to be classified as having SLE. These classification criteria are not diagnostic criteria; they were developed for research purposes to provide some attempt at standardisation for entry into clinical trials or outcome studies. The criteria do not have to be present simultaneously but can be cumulative over a
The disease activity indices
There is no gold standard for measuring disease activity in lupus and the physicians' visual analogue scale is not reliable in practice.19, 20 Although the physician's opinion is often considered the ‘gold standard’ for the evaluation of disease activity, it is evident that there is bias based on personal experience and different opinions on the relative merits of disease activity in different systems.20 Thus, an experience-based evaluation of activity cannot allow comparisons of data because
Assessment of damage
The treatment of lupus has improved. Fewer patients are dying early in their disease than 20–30 years ago.67 However, more patients are dying of the complications of lupus and the co-morbidities associated with lupus later in life, such as premature coronary and cerebrovascular disease67, 68. These complications are also causing increasing morbidity in lupus patients, at a time when the disease activity has usually been controlled by immunosuppressive therapy.
A group of investigators interested
Assessment of quality of life
From the patient's perspective it is important to consider health status/quality of life when assessing patients with lupus. To date, generic health status questionnaires have been used to formally assess the health-related quality of life of patients with lupus. The Short Form 36 (SF-36) has been most widely used.47 It covers eight domains assessing physical function, social function, role limitation due to physical or emotional factors, mental health, vitality, pain and general health
Summary
The assessment of a lupus patient is complex and requires a holistic approach. Disease activity, damage, health-related quality of life and the prevention of complications, including drug side effects, should be included in the assessment. With the development of new drugs and the need of controlled randomised studies, the evaluation of disease activity has become of paramount importance to select candidate patients for trials and to assess drug efficacy. Assessment of disease activity is also
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