To determine the level of agreement of disease flare severity (distinguishing severe, moderate and mild flare and persistent disease activity) in a large paper patient exercise involving 988 individual cases of systemic lupus erythematosus.
988 individual lupus case histories were assessed by three individual physicians. Complete agreement about the degree of flare (or persistent disease activity) was obtained in 451 cases (46%) and these provided the reference standard for the second part of the study. This component utilised three flare activity instruments (BILAG 2004, SELENA flare index (SFI) and the revised SELENA flare index (rSFI)). The 451 patient case histories were distributed to 18 pairs of physicians being carefully randomised in a manner designed to ensure a fair case mix and equal distribution of flare according to severity.
The three physician assessment of flare matched the level of flare using the three indices thus 67% for BILAG 2004, 72% for SFI and 70% for rSFI. The corresponding weighted kappas for each instrument were 0.82, 0.59 and 0.74 respectively. We undertook a detailed analysis of the discrepant cases and several factors emerged including a tendency to score moderate flares as severe and persistent activity as flare especially when the SFI and rSFI instruments were used. Overscoring was also driven by scoring treatment change as flare even if there were no new or worsening clinical features.
Given the complexity of assessing lupus flare, we were encouraged by the overall results reported. However the problem of capturing lupus flare accurately is not completely solved. This article is protected by copyright. All rights reserved.
This research output has an Altmetric Attention Score of 27. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 20 January 2023.
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Altmetric has tracked 24,525,936 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 94th percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
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We're also able to compare this research output to 53 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 69% of its contemporaries.
