Preliminary criteria for global flares in childhood-onset systemic lupus erythematosus

Hermine I. Brunner, Rina Mina, Clarissa Pilkington, Michael W. Beresford, Andreas Reiff, Deborah M. Levy, Lori B. Tucker, B. Anne Eberhard, Angelo Ravelli, Laura E. Schanberg, Claudia Saad-Magalhaes, Gloria C. Higgins, Karen Onel, Nora G. Singer, Emily Von Scheven, Lukasz Itert, Marisa S. Klein-Gitelman, Marilynn Punaro, Jun Ying, Edward H. Giannini

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective To develop widely acceptable preliminary criteria of global flare for childhood-onset systemic lupus erythematosus (cSLE). Methods Pediatric rheumatologists (n = 138) rated a total of 358 unique patient profiles with information about the cSLE flare descriptors from 2 consecutive visits: patient global assessment of well-being, physician global assessment of disease activity (MD-global), health-related quality of life, anti-double-stranded DNA antibodies, disease activity index scores, protein:creatinine (P:C) ratio, complement levels, and erythrocyte sedimentation rate (ESR). Based on 2,996 rater responses about the course of cSLE (baseline versus followup), the accuracy (sensitivity, specificity, and area under the receiver operating characteristic curve) of candidate flare criteria was assessed. An international consensus conference was held to rank these candidate flare criteria as per the American College of Rheumatology recommendations for the development and validation of criteria sets. Results The highest-ranked candidate criteria considered absolute changes (Δ) of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) or British Isles Lupus Assessment Group (BILAG), MD-global, P:C ratio, and ESR; flare scores can be calculated (0.5 × ΔSLEDAI + 0.45 × ΔP:C ratio + 0.5 × ΔMD-global + 0.02 × ΔESR), where values of ≥1.04 are reflective of a flare. Similarly, BILAG-based flare scores (0.4 × ΔBILAG + 0.65 × ΔP:C ratio + 0.5 × ΔMD-global + 0.02 × ΔESR) of ≥1.15 were diagnostic of a flare. Flare scores increased with flare severity. Conclusion Consensus has been reached on preliminary criteria for global flares in cSLE. Further validation studies are needed to confirm the usefulness of the cSLE flare criteria in research and for clinical care.

Original languageEnglish (US)
Pages (from-to)1213-1223
Number of pages11
JournalArthritis Care and Research
Volume63
Issue number9
DOIs
StatePublished - Sep 2011

Fingerprint

Systemic Lupus Erythematosus
Blood Sedimentation
Creatinine
Proteins
Validation Studies
ROC Curve
Quality of Life
Pediatrics
Physicians
Sensitivity and Specificity
Antibodies
DNA
Research

ASJC Scopus subject areas

  • Rheumatology

Cite this

Brunner, H. I., Mina, R., Pilkington, C., Beresford, M. W., Reiff, A., Levy, D. M., ... Giannini, E. H. (2011). Preliminary criteria for global flares in childhood-onset systemic lupus erythematosus. Arthritis Care and Research, 63(9), 1213-1223. https://doi.org/10.1002/acr.20507

Preliminary criteria for global flares in childhood-onset systemic lupus erythematosus. / Brunner, Hermine I.; Mina, Rina; Pilkington, Clarissa; Beresford, Michael W.; Reiff, Andreas; Levy, Deborah M.; Tucker, Lori B.; Eberhard, B. Anne; Ravelli, Angelo; Schanberg, Laura E.; Saad-Magalhaes, Claudia; Higgins, Gloria C.; Onel, Karen; Singer, Nora G.; Von Scheven, Emily; Itert, Lukasz; Klein-Gitelman, Marisa S.; Punaro, Marilynn; Ying, Jun; Giannini, Edward H.

In: Arthritis Care and Research, Vol. 63, No. 9, 09.2011, p. 1213-1223.

Research output: Contribution to journalArticle

Brunner, HI, Mina, R, Pilkington, C, Beresford, MW, Reiff, A, Levy, DM, Tucker, LB, Eberhard, BA, Ravelli, A, Schanberg, LE, Saad-Magalhaes, C, Higgins, GC, Onel, K, Singer, NG, Von Scheven, E, Itert, L, Klein-Gitelman, MS, Punaro, M, Ying, J & Giannini, EH 2011, 'Preliminary criteria for global flares in childhood-onset systemic lupus erythematosus', Arthritis Care and Research, vol. 63, no. 9, pp. 1213-1223. https://doi.org/10.1002/acr.20507
Brunner HI, Mina R, Pilkington C, Beresford MW, Reiff A, Levy DM et al. Preliminary criteria for global flares in childhood-onset systemic lupus erythematosus. Arthritis Care and Research. 2011 Sep;63(9):1213-1223. https://doi.org/10.1002/acr.20507
Brunner, Hermine I. ; Mina, Rina ; Pilkington, Clarissa ; Beresford, Michael W. ; Reiff, Andreas ; Levy, Deborah M. ; Tucker, Lori B. ; Eberhard, B. Anne ; Ravelli, Angelo ; Schanberg, Laura E. ; Saad-Magalhaes, Claudia ; Higgins, Gloria C. ; Onel, Karen ; Singer, Nora G. ; Von Scheven, Emily ; Itert, Lukasz ; Klein-Gitelman, Marisa S. ; Punaro, Marilynn ; Ying, Jun ; Giannini, Edward H. / Preliminary criteria for global flares in childhood-onset systemic lupus erythematosus. In: Arthritis Care and Research. 2011 ; Vol. 63, No. 9. pp. 1213-1223.
@article{4a97401b94484fdca56b2159e4c1d7b3,
title = "Preliminary criteria for global flares in childhood-onset systemic lupus erythematosus",
abstract = "Objective To develop widely acceptable preliminary criteria of global flare for childhood-onset systemic lupus erythematosus (cSLE). Methods Pediatric rheumatologists (n = 138) rated a total of 358 unique patient profiles with information about the cSLE flare descriptors from 2 consecutive visits: patient global assessment of well-being, physician global assessment of disease activity (MD-global), health-related quality of life, anti-double-stranded DNA antibodies, disease activity index scores, protein:creatinine (P:C) ratio, complement levels, and erythrocyte sedimentation rate (ESR). Based on 2,996 rater responses about the course of cSLE (baseline versus followup), the accuracy (sensitivity, specificity, and area under the receiver operating characteristic curve) of candidate flare criteria was assessed. An international consensus conference was held to rank these candidate flare criteria as per the American College of Rheumatology recommendations for the development and validation of criteria sets. Results The highest-ranked candidate criteria considered absolute changes (Δ) of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) or British Isles Lupus Assessment Group (BILAG), MD-global, P:C ratio, and ESR; flare scores can be calculated (0.5 × ΔSLEDAI + 0.45 × ΔP:C ratio + 0.5 × ΔMD-global + 0.02 × ΔESR), where values of ≥1.04 are reflective of a flare. Similarly, BILAG-based flare scores (0.4 × ΔBILAG + 0.65 × ΔP:C ratio + 0.5 × ΔMD-global + 0.02 × ΔESR) of ≥1.15 were diagnostic of a flare. Flare scores increased with flare severity. Conclusion Consensus has been reached on preliminary criteria for global flares in cSLE. Further validation studies are needed to confirm the usefulness of the cSLE flare criteria in research and for clinical care.",
author = "Brunner, {Hermine I.} and Rina Mina and Clarissa Pilkington and Beresford, {Michael W.} and Andreas Reiff and Levy, {Deborah M.} and Tucker, {Lori B.} and Eberhard, {B. Anne} and Angelo Ravelli and Schanberg, {Laura E.} and Claudia Saad-Magalhaes and Higgins, {Gloria C.} and Karen Onel and Singer, {Nora G.} and {Von Scheven}, Emily and Lukasz Itert and Klein-Gitelman, {Marisa S.} and Marilynn Punaro and Jun Ying and Giannini, {Edward H.}",
year = "2011",
month = "9",
doi = "10.1002/acr.20507",
language = "English (US)",
volume = "63",
pages = "1213--1223",
journal = "Arthritis and Rheumatology",
issn = "2326-5191",
publisher = "John Wiley and Sons Ltd",
number = "9",

}

TY - JOUR

T1 - Preliminary criteria for global flares in childhood-onset systemic lupus erythematosus

AU - Brunner, Hermine I.

AU - Mina, Rina

AU - Pilkington, Clarissa

AU - Beresford, Michael W.

AU - Reiff, Andreas

AU - Levy, Deborah M.

AU - Tucker, Lori B.

AU - Eberhard, B. Anne

AU - Ravelli, Angelo

AU - Schanberg, Laura E.

AU - Saad-Magalhaes, Claudia

AU - Higgins, Gloria C.

AU - Onel, Karen

AU - Singer, Nora G.

AU - Von Scheven, Emily

AU - Itert, Lukasz

AU - Klein-Gitelman, Marisa S.

AU - Punaro, Marilynn

AU - Ying, Jun

AU - Giannini, Edward H.

PY - 2011/9

Y1 - 2011/9

N2 - Objective To develop widely acceptable preliminary criteria of global flare for childhood-onset systemic lupus erythematosus (cSLE). Methods Pediatric rheumatologists (n = 138) rated a total of 358 unique patient profiles with information about the cSLE flare descriptors from 2 consecutive visits: patient global assessment of well-being, physician global assessment of disease activity (MD-global), health-related quality of life, anti-double-stranded DNA antibodies, disease activity index scores, protein:creatinine (P:C) ratio, complement levels, and erythrocyte sedimentation rate (ESR). Based on 2,996 rater responses about the course of cSLE (baseline versus followup), the accuracy (sensitivity, specificity, and area under the receiver operating characteristic curve) of candidate flare criteria was assessed. An international consensus conference was held to rank these candidate flare criteria as per the American College of Rheumatology recommendations for the development and validation of criteria sets. Results The highest-ranked candidate criteria considered absolute changes (Δ) of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) or British Isles Lupus Assessment Group (BILAG), MD-global, P:C ratio, and ESR; flare scores can be calculated (0.5 × ΔSLEDAI + 0.45 × ΔP:C ratio + 0.5 × ΔMD-global + 0.02 × ΔESR), where values of ≥1.04 are reflective of a flare. Similarly, BILAG-based flare scores (0.4 × ΔBILAG + 0.65 × ΔP:C ratio + 0.5 × ΔMD-global + 0.02 × ΔESR) of ≥1.15 were diagnostic of a flare. Flare scores increased with flare severity. Conclusion Consensus has been reached on preliminary criteria for global flares in cSLE. Further validation studies are needed to confirm the usefulness of the cSLE flare criteria in research and for clinical care.

AB - Objective To develop widely acceptable preliminary criteria of global flare for childhood-onset systemic lupus erythematosus (cSLE). Methods Pediatric rheumatologists (n = 138) rated a total of 358 unique patient profiles with information about the cSLE flare descriptors from 2 consecutive visits: patient global assessment of well-being, physician global assessment of disease activity (MD-global), health-related quality of life, anti-double-stranded DNA antibodies, disease activity index scores, protein:creatinine (P:C) ratio, complement levels, and erythrocyte sedimentation rate (ESR). Based on 2,996 rater responses about the course of cSLE (baseline versus followup), the accuracy (sensitivity, specificity, and area under the receiver operating characteristic curve) of candidate flare criteria was assessed. An international consensus conference was held to rank these candidate flare criteria as per the American College of Rheumatology recommendations for the development and validation of criteria sets. Results The highest-ranked candidate criteria considered absolute changes (Δ) of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) or British Isles Lupus Assessment Group (BILAG), MD-global, P:C ratio, and ESR; flare scores can be calculated (0.5 × ΔSLEDAI + 0.45 × ΔP:C ratio + 0.5 × ΔMD-global + 0.02 × ΔESR), where values of ≥1.04 are reflective of a flare. Similarly, BILAG-based flare scores (0.4 × ΔBILAG + 0.65 × ΔP:C ratio + 0.5 × ΔMD-global + 0.02 × ΔESR) of ≥1.15 were diagnostic of a flare. Flare scores increased with flare severity. Conclusion Consensus has been reached on preliminary criteria for global flares in cSLE. Further validation studies are needed to confirm the usefulness of the cSLE flare criteria in research and for clinical care.

UR - http://www.scopus.com/inward/record.url?scp=80052286152&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80052286152&partnerID=8YFLogxK

U2 - 10.1002/acr.20507

DO - 10.1002/acr.20507

M3 - Article

C2 - 21618452

AN - SCOPUS:80052286152

VL - 63

SP - 1213

EP - 1223

JO - Arthritis and Rheumatology

JF - Arthritis and Rheumatology

SN - 2326-5191

IS - 9

ER -