Comparison of the validity and sensitivity to change of 5 activity indices in systemic lupus erythematosus. A new tool -- the Lupus Activity Scoring Tool (LAST) - has been proposed to join the ranks of current disease activity indices. may be asked to hyperventilate 3-4 min and watch a bright flashing light. Management of systemic lupus erythematosus (SLE) often depends on disease severity and disease manifestations, [] although hydroxychloroquine has a central role for long-term treatment in all SLE patients. AU - Morand, Eric. Published by Oxford University Press on behalf of the British Society for Rheumatology. The content can vary and relates either to global health (e . , Shea BJ BATCH RUBY INTENSIVE REVIEWRTRMF 3. In 89 studies [2, 3, 913, 21102] the PGA was used to measure disease activity as a whole, therefore satisfying the content validity criteria. The Physician Global Assessment (PGA) is an important tool for assessing disease activity in lupus. Ward et al. Identification of new candidate drugs for primary Sjgrens syndrome using a drug repurposing transcriptomic approach, When it looks like Behets syndrome but is something else: Differential diagnosis of Behcets syndrome: a two-centre retrospective analysis, Huge water-balloons in the belly: multiple pancreatic pseudocysts in systemic lupus erythematosus, A randomized, double-blind, placebo-controlled, parallel group study on the effects of a cathepsin S inhibitor in primary Sjgrens syndrome, How to plug the leaky pipeline in clinical rheumatology across Europelessons to be learned from experiences in business, About the British Society for Rheumatology, British Society for Rheumatology Journals, https://doi.org/10.1093/rheumatology/keaa383, https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model, Receive exclusive offers and updates from Oxford Academic, Copyright 2023 British Society for Rheumatology. , Skogh T The last EULAR/ACR recommendations recommended use of the PGA in the routine monitoring of SLE [16]. The company serves physicians and patients. Navarra SV However, the PGA allows for the measurement of disease activity in a global way (content validity). et al. In one study [25], the PGA of disease activity resulted from the combination of the clinical visit, laboratory markers evaluation and the physicians knowledge of the patient disease history. , Liberati A An official website of the United States government. , Arora S et al. , Ding HH 1), accounting for 49 longitudinal cohort studies, 25 cross-sectional studies, 7 randomized controlled trials, 3 consensus conferences, 4 post-hoc analyses, 2 retrospective studies and 1 case series. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Physician Global Assessment (PGA) is a visual analogue score (VAS) that reflects the clinician's judgment of overall Systemic Lupus Erythematosus (SLE) disease activity. The Janus kinase (Jak)/signal transducer and activating protein (STAT) pathways mediate the intracellular signaling of cytokines in a wide spectrum of cellular processes. Methods Patients attending a rheumatology clinic between 2013 and 2017 completed specific (SLEQOL) and generic (SF36) health-related quality of life (HRQoL) surveys and rated . Franklyn K Clipboard, Search History, and several other advanced features are temporarily unavailable. BICLA is a validated composite global measure of SLE disease activity including SLEDAI-2K, CLASI-A, OCS dosage reduction, and patient-reported outcomes. One study showed a significant ability of the PGA in distinguishing between patients (P<0.0001) and observers (P<0.0001), but not between visits [79]. To increase its reliability, the PGA should be scored by a physician with significant expertise in SLE, with prior knowledge of laboratory results [112], considering the overall disease activity at the time of the visit and comparing it to the last visit in order to assess flares [9]. , Giannakou I Uribe AG, Vil LM, McGwin G Jr, Sanchez ML, Reveille JD, Alarcn GS. JSS Medical Research. Aranow C Truth refers to whether the measure provided by the scores is able to measure what was intended [18]. et al. , Perez-Gutthann S In 11 retrieved studies [10, 13, 33, 36, 45, 48, 50, 55, 56, 65, 96] the PGA was part of the SFI [104] and in 10 studies [3, 29, 40, 46, 52, 60, 69, 80, 94, 98] it was part of the SRI [3] (both discussed in the Responsiveness section). Whenever papers reported duplicate data, the most recent article was selected. Improving patient pathways for systemic lupus erythematosus: a multistakeholder pathway optimisation study. et al. Clinical composite measures of disease activity and damage used to evaluate patients with systemic lupus erythematosus: A systematic literature review. All articles published through 1 July 2019 in PubMed were screened, with no limitation on year of publication, language or patients age. The PGA is a well accepted and commonly used scale for evaluating treatment response in clinical trials both in adults and children. It is therefore desirable to use the PGA along with other tools (typically the SLEDAI) or to include the PGA in a composite index (e.g. , Mikolaitis-Preuss RA Sullivan KE , Raeisi A T1 - Associations between physicians' global assessment of disease activity and patient-reported outcomes in patients with systemic lupus erythematosus. , Floris A Convergent validity is fulfilled indirectly in studies where the PGA is used as the gold standard to assess the construct validity of other indices. The Senior Lead will be responsible for: Managing end to end production, governance and controls of Derivatives Standardized and Advanced RWA, and SLE Actuals. The geographical analysis of the Global Global Respiratory Devices market provided in the report is just the right tool that competitors can use to discover untapped sales and business expansion . , Klein-Gitelman MS Moher D SLE is an immune-mediated multisystemic disease characterized by a wide variability of clinical manifestations and a course frequently subject to unpredictable flares [1, 2]. , Schur PH. , Hochberg M. Touma Z Fanouriakis A This is a top barrier, both for treat-to-target management of SLE patients in clinical practice, as well as in clinical trials for new SLE treatments. , Askanase A Parodis I In an epratuzumab trial, the absence of deterioration of the PGA (not >10% worsening) was one of the items to achieve a BILAG-based Composite Lupus Assessment (BICLA) response [105]. ECG - correct answer no sleep the night before, meals allowed, no stimulants/tranquilizers for 24-48 hours before. , Morabito LM According to the authors, this difference was probably due to the greater familiarity of the physicians with the BILAG-2004 index. 2019ACREULAR . The aim of this systematic literature review (SLR) is to describe and analyse the psychometric properties of PGA. (PGA) scoring of disease activity in systemic lupus erythematosus (SLE). Please check for further notifications by email. PGA is a valid, responsive and feasible instrument, though its reliability was impacted by the scale adopted, suggesting the major need for standardization of its scoring. et al. Patient-reported outcomes (PROs) reflect the patient's perspective and are used in rheumatoid arthritis (RA) routine clinical practice. , Henriques C , Ravelli A , Devilliers H For instance, in an analysis of studies of the prevalence of SLE in the Asia-Pacific region, higher rates of renal involvement were observed in Asian patients (21-65% at SLE diagnosis and 40 . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Montreal, Canada Area. et al. Psychometric properties data were analysed according to the OMERACT Filter methodology version 2.1. et al. , Garabajiu M In 16 studies the PGA was used as a mean to assess changes in disease activity after treatment [3, 12, 22, 29, 40, 42, 43, 52, 54, 56, 57, 80, 85, 87, 95, 98, 101]. , Mohan C. Giangreco D , Ibanez D , Devilliers H The SELENA-SLEDAI assesses systemic lupus erythematosus (SLE) disease activity and categorizes mild/moderate or severe flares based on changes in the SLEDAI score, the Physician's Global Assessment (PGA), medication use (prednisone, Nonsteroidal anti-inflammatory drugs, Plaquenil, major immunosuppressives), other disease activity criteria, and . PGA is a simple instrument and the result is easily understood. Responsiveness. , Kalunian K Different definitions of PGA retrieved through the literature search are reported in Table1. Cloud, mobility, security, and more. Published by Oxford University Press on behalf of the British Society for Rheumatology. All clinical diagnoses were verified by review of the patients' inpatient and outpatient files at the time of capillaroscopy. , Hearth-Holmes M. Khan A , Kandane-Rathnayake RK , Burlingame RW , Ko T OBJECTIVE The Physician Global Assessment (PGA) is a visual analogue score that reflects the clinician's judgement of overall SLE disease activity. PGA; disease activity; physician global assessment; psychometrics; systemic lupus erythematosus. The PGA was developed on a 0 to 3 scale as part of the Lupus Activity Index. Thanou A, Chakravarty E, James JA, Merrill JT. et al. et al. It estimates how similar a given patients scores were at the two visits. Beaton DE Correspondence to: Laurent Arnaud, Service de Rhumatologie, Centre National de Rfrence des Maladies Autoimmunes et Systmiques Rares, Hpital de Hautepierre, 1 Avenue Molire BP 83049, 67098 Strasbourg Cedex, France. The Author(s) 2020. Criterion validity was assessed exploring the PGA correlation with quality of life measurements, biomarker levels and treatment changes in 28 studies, while no study has evaluated correlation with damage. 25 (FIVE YEARS 8) Latest Documents Most Cited Documents Contributed Authors Related Sources Related Keywords Latest Documents; Most Cited Documents; Contributed Authors; Related Sources; , Andreoli L Fatigue is independently associated with disease activity assessed using the Physician Global Assessment but not the SLEDAI in patients with systemic lupus erythematosus. , Altman DG It operates in Albuquerque, and New Mexico. , Longenecker JC et al. Despite the need for new treatments in CLE . This site needs JavaScript to work properly. For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Pincus and colleagues conducted a study of . , Weisman MH. 2022 Sep 20;19(19):11895. doi: 10.3390/ijerph191911895. Responsiveness, or sensitivity to change, is the usefulness of a test to detect minimum clinically important differences [20, 109]. doi: 10.1136/lupus-2022-000700. This enabled the PGA to be considered the gold standard in several studies [2, 10, 11, 21, 23, 49, 67, 76, 78, 84, 88]. et al. BICLA responders had fewer lupus-related serious . Oxford University Press is a department of the University of Oxford. physician global assessment Recently Published Documents. Reliability was excellent when scored through a pointed scale, such as the Likert scale, that was anchored in unit numbers from 0 (not active) to 7 (most active) (interRR ICC 0.96; intraRR ICC 0.88) [80], but was lower when assessed through a centimetric VAS using values between 0.0 and 3.0 (interRR ICC 0.67; intraRR ICC 0.55) [68]. 2021 Apr 8;5(1):33. doi: 10.1186/s41687-021-00298-x. Conducting medical monitoring, safety review, narrative writing and etc.. Perform medical assessment of individual . , Wetter J MeSH doi: 10.1136/rmdopen-2022-002395. No study has evaluated the feasibility of the PGA in SLE to date. Because of the complexity of SLE, the assessment of disease activity is particularly challenging [3]. Higher disease activity is an important predictor of both organ damage and mortality [2] and the attainment of low disease activity is associated with a reduction in early damage [5, 6]. The Physician Global Assessment (PGA) has been shown to be a valid, responsive, and feasible instrument to capture disease activity in systemic lupus erythematosus (SLE), but its low reliability further supports the need for a standardisation of its scoring. et al. Face validity. A good responsiveness for PGA was shown in eight studies. Thanks to this feature, the PGA was included in composite indices with the aim of rating manifestations not included in glossary-based instruments such as the SLEDAI and BILAG [3] or for which a threshold has been defined (cytopenia). http://oml.eular.org/glossary (31 January. , Francis S The random effects model gives a more conservative estimate considering the heterogeneity. Touma Z It was published in 1977 and was initially designed for the measurement of self-assessed pain in rheumatoid arthritis although it has since been used to evaluate RA more globally. , Adamichou C Barr et al. Ensure second line of defense Derivatives RWA reviews are performed consistently and . , Voskuyl A , Sjwall C Rheumatology (Oxford). [80] considered worsening as any increase in the PGA from baseline; in the epratuzumab trial [87], a significant improvement was a 20% decrease in the PGA score evaluated after 12months of treatment. , James JA , McGuire JL. , Chakravarty E et al. , Petri M. Thanou A Background Physician Global Assessment (PGA) is a visual analogue score (VAS) that reflects the clinician's judgment of overall Systemic Lupus Erythematosus (SLE) disease activity. The SRI is a validated SLE disease activity instrument used to detect clinically meaningful improvement of disease in SLE clinical trials. , Arbab-Zadeh A In the absence of a well-recognized gold standard for disease activity, criterion validity of the PGA is established when it correlates with a measure that the author of the study defined a priori as the gold standard. The pooled correlation coefficient (95% CI) is given both for the fixed effects model and the random effects model. PGA is a valid, responsive and feasible instrument, while its reliability was impacted by the scale adopted, suggesting the major need for a standardization of its scoring. Neuropsychiatry OXFORD TEXTBOOKS IN PSYCHIATRY Oxford Textbook of Neuropsychiatry Edited by Niruj Agrawal, Rafey Faruqui, and Mayur Bodani Oxford Textbook of Psychiatry of Intellectual Disability Edited by Sabyasachi Bhaumik and Regi Alexander Oxford Textbook of Inpatient Psychiatry Edited by Alvaro Barrera, Caroline Attard, and Rob Chaplin Oxford Textbook of Attention . Few studies reported on whether serological activity should be incorporated in the PGA. Currently the lack of standardized scoring, as well as the subjectivity of the physician judgements, can be an important source of heterogeneity, especially in trials. , Kostopoulou M The last MEDLINE search was performed on 1 July 2019. SLE has protean and often complex manifestations, necessitating careful clinical assessment. , Piette EW , Engle E The Patient's Global Assessment Scale (PGA) is the PRO counterpart to the Physician's Global Assessment Scale or Investigator's Global Assessment Scale (PGA-IGA). IgM) on attainment PhGA. , Siega-Riz AM Gandhi N , Cappellazzo G PGA is often assessed by a single question with a 0-10 or 0-100 response. , Klein-Gitelman MS Definition: At least a 20%, 40%, 50%, or 70% improvement and an absolute improvement of at least 1 unit on a scale of 1-10 in at least three of the following criteria: patient global assessment; pain; function (BASFI); and. Background/Purpose: The Physician Global Assessment (PGA) is a frequently-used outcome measure in Systemic Lupus Erythematosus (SLE). Jiao H, Acar G, Robinson GA, Ciurtin C, Jury EC, Kalea AZ. , Bonithon-Kopp C , Khamashta MA Jesus D , Mosca M Piga M This important heterogeneity in the anchoring of the PGA prevented us from performing a meta-analysis of reliability data. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels. The judgment of whether a patient with SLE has active disease is a central question both in routine patient management and in clinical research [4]. This potentially disfiguring disease can have significant impact on patient's quality of life (QoL) and is often refractory to many first- and second-line therapies. , Kiani AN Supporting the face validity property, PGA was defined the gold standard in 11 studies [2, 10, 11, 21, 23, 49, 67, 76, 78, 84, 88] and in 32 it was used as the reference to which other activity scores were compared, such as the SLEDAI [4, 10, 13, 25, 27, 28, 31, 33, 35, 36, 41, 46, 47, 50, 51, 53, 62, 65, 68, 72, 73, 76, 81, 9699], BILAG [4, 27, 35, 36, 46, 65, 72, 73, 81, 98], SLAM [4, 72, 76, 99], LAI [68, 88], patient global assessment [81, 83, 84] and ECLAM [35]. , Rairie JE Data regarding divergent validity are lacking for the PGA. Matthew Turk,1,2 Janet E Pope1,2 To cite: turk M, Pope Je. , Urowitz MB , Block JA , Roberts WN , Engleman EG The PGA is usually reported by experts as allowing exhaustive coverage of the concept of disease activity in SLE [20, 108]. , Hynan LS In most studies, the PGA was assessed by a rheumatologist experienced in SLE care or research and, as already stated, the ICC reliability was different for an untrained physician and a trained investigator [36]. A 21-numbered circle visual analog scale (VAS) may be a desirable alternative to the traditional 10-cm horizontal line for pain and patient global estimate on a Multidimensional Health Assessment Questionnaire (MDHAQ). Face validity was reported in all the articles retrieved in which the PGA was used alone or as part of composite indices (Systemic Responder Index, Safety of Estrogen in Lupus Erythematosus National Assessment Flare Index, Lupus Low Disease Activity State, Definitions of Remission in Systemic Lupus Erythematosus criteria). Physician's Global Assessment (PGA) score 1.0 on a 0 to 3 visual analog scale. Liang MH This study assesses the reliability of the PGA, measured by means of 0-100 mm visual analog scale (VAS), and the additional use of separate VAS scales for musculoskeletal (PhysMSK) and dermatologic (PhysSk) manifestations in patients with psoriatic arthritis (PsA). , Sadovici-Bobeica V 2) [10, 23, 24, 26, 28, 29, 35, 54, 68, 76, 84, 99], with the SLAM in 4 studies (r=0.470.65) [35, 76, 84, 99], with LAI in 2 studies (r=0.640.75) [68, 84], with BILAG in 2 studies (r=0.610.62) [35, 84] and with ECLAM in 2 studies (r=0.580.65) [35, 84]. , Terwee CB In one study, the PGA was part of a modified score to assess disease activity in pregnancy (the SLE in Pregnancy Disease Activity Index) [51]. In 1988, Liang et al. , Beresford MW , Gladman DD Before Because of its dynamic nature, this disease has an unpredictable natural course leading to high . physician's global assessment (PGA) of disease activity in SLE. , Carpenter AB Petri M An acceptable reliability is indicated by values of intraclass correlation coefficient (ICC) or weighted >0.60 and a good reliability is >0.85 [20]. , Magder L How should lupus flares be measured? Exagen's products are used for therapeutic drug monitoring of hydroxychloroquine in whole blood and methotrexate polyglutamates, risk assessment testing, anti-TNF monitoring to individualize therapy and optimize dosing, and others. The assessment of PGA responsiveness was performed in 10 studies [4, 23, 50, 58, 7779, 81, 83, 84] using different methods [110]. Medical-Surgical Nursing Clinical Lab (NUR1211L) U.S. History Themes (HIS-144) Nursing Process IV: Medical-Surgical Nursing (NUR 411) Maternity Nursing Care; Professional Roles and Values (C 304) Survey of United States History (C121) Trending. , Sato JO Construct validity is the degree to which the PGA relates to other instruments that measure the same concept [18]. , Tetzlaff J van Vollenhoven R Methods: SLE2ACR1997SLICC2012. Direkt zum Inhalt springen . Compared with nonresponders, BICLA responders had greater improvements in global and organ-specific disease activity (Physician's Global Assessment, SLE Disease Activity Index 2000, Cutaneous Lupus Erythematosus Disease Area and Severity Index Activity, and joint counts; all nominal P < 0.001). A good correlation was considered for a value >0.60. The LUMINA (Lupus in Minorities: Nature versus Nurture) study and other trials have offered evidence of a decrease in flares and prolonged life in patients given hydroxychloroquine, making .
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