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Organ Manifestations Influence Differently the Responsiveness of 2 Lupus Disease Activity Measures, According to Patients' or Physicians' Evaluations of Recent Lupus Activity ERIKA R. CHANG, MICHAL ABRAHAMOWICZ, DIANE FERLAND, and PAUL R. FORTIN, for CaNIOS Investigators
ABSTRACT.
Methods. Blinded data were obtained from repeated visits of 76 patients in the Study of Methotrexate in Lupus Erythematosus. At each visit, physicians and patients reported improvement, no change, or deterioration, and physicians then completed SLAM-R and SLEDAI. Items in SLAM-R and SLEDAI were grouped by organ system. The generalized estimating equations approach was used to measure associations between change in organ system activity and physician or patient perception of change in overall disease activity. The outcomes assessed, in separate analyses, were improvement and deterioration from the previous visit. Results. Seventy-six patients contributed a total of 471 observations. The strongest correlates of physician-reported improvement were decreased constitutional, gastrointestinal (GI), and musculoskeletal involvement (components of SLAM-R), and decreased musculoskeletal (MSK) and central nervous system involvement (SLEDAI). Improvement reported by patients was most strongly associated with decreases in erythrocyte sedimentation rate and MSK and reticuloendothelial activity (SLAM-R), and in MSK activity (SLEDAI). Increased integument and MSK subscores (SLAM-R) and serosal and MSK subscores (SLEDAI) were associated with overall deterioration reported by physicians. Patient-reported deterioration was associated with increased GI subscores (SLAM-R) and with no changes in organ system involvement in SLEDAI. Conclusion. Organ systems associated with reported change in overall SLE activity differed between SLAM-R and SLEDAI, between patients and physicians, and between each direction of change. (J Rheumatol 2002;29:2350-8) Key Indexing Terms:
SYSTEMIC LUPUS ERYTHEMATOSUS From The Arthritis Centre of Excellence, the Division of Rheumatology, the Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec; Division of Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec; and the Canadian Network for Improved Outcomes in SLE (CaNIOS). Supported in part by grants from the Canadian Arthritis Network, The Arthritis Society (Grant 95072), and the Natural Sciences and Engineering Research Council of Canada (Grant 105521-98). Dr. Abrahamowicz is a Health Scientist of the Canadian Institutes of Health Research. Dr. Fortin is a Senior Research Scholar of The Arthritis Society. E.R. Chang, MSc, Research Associate, The Arthritis Centre of Excellence, University Health Network, University of Toronto; M. Abrahamowicz, PhD, Associate Professor of Biostatistics, Department of Epidemiology and Biostatistics, McGill University, Division of Clinical Epidemiology, Montreal General Hospital; D. Ferland, BScN, CaNIOS National Coordinator, The Arthritis Centre of Excellence, University Health Network, University of Toronto; P.R. Fortin, MD, MPH, Division of Rheumatology, Toronto Western Hospital Associate Professor of Medicine, Director of Clinical Research, Arthritis Centre of Excellence, University Health Network, University of Toronto. Address reprint requests to Dr. M. Abrahamowicz, Division of Clinical Epidemiology, The Montreal General Hospital, 1650 Cedar Ave., Room L10-520, Montreal, Quebec H3G 1A4. E-mail: michal@michal.ri.mgh.mcgill.ca Submitted February 6, 2002; revision accepted May 9, 2002.
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