scholarly journals Use of Physician Global Assessment in systemic lupus erythematosus: a systematic review of its psychometric properties

Rheumatology ◽  
2020 ◽  
Vol 59 (12) ◽  
pp. 3622-3632
Author(s):  
Elisabetta Chessa ◽  
Matteo Piga ◽  
Alberto Floris ◽  
Hervé Devilliers ◽  
Alberto Cauli ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Literature Review ◽  
Disease Activity ◽  
Psychometric Properties ◽  
Systematic Literature Review ◽  
Lupus Erythematosus ◽  
Global Assessment ◽  
Physician Global Assessment ◽  
Systemic Lupus ◽  
Wide Range

Abstract Objective The Physician Global Assessment (PGA) is a visual analogue score that reflects the clinician’s judgement of overall SLE disease activity. The aim of this systematic literature review is to describe and analyse the psychometric properties of the PGA. Methods This systematic literature review was conducted by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All articles published through 1 July 2019 in PubMed were screened, with no limitation on year of publication, language or patients’ age. Psychometric properties data were analysed according to the OMERACT Filter methodology version 2.1. Results The literature search identified 91 studies. 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). Content validity was reported in 89 studies. Construct validity was demonstrated by a good correlation (r ≥ 0.50) between the PGA with the SLEDAI (12 studies), SLAM (4 studies), LAI, BILAG and ECLAM (2 studies each). 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. A good responsiveness for PGA was shown in eight studies. A high variability in scales was found, causing a wide range of reliability (intraclass correlation coefficient 0.67–0.98). Conclusion 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.

scholarly journals Use of Physician Global Assessment (PGA) in Systemic lupus erythematosus: a systematic review of its psychometric properties

2020 ◽  
Author(s):  
Elisabetta Chessa ◽  
Matteo Piga ◽  
Alberto Floris ◽  
Hervé Devilliers ◽  
Alberto Cauli ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Psychometric Properties ◽  
Lupus Erythematosus ◽  
Global Assessment ◽  
Visual Analogue Score ◽  
Face Validity ◽  
Physician Global Assessment ◽  
Systemic Lupus ◽  
Wide Range ◽  
Remission Criteria

ABSTRACTBackgroundPhysician Global Assessment (PGA) is a visual analogue score (VAS) that reflects the clinician’s judgment of overall Systemic Lupus Erythematosus (SLE) disease activity. The aim of this systematic literature review (SLR) is to describe and analyse the psychometric properties of PGA.MethodsThis SLR was conducted by two independent reviewers in accordance with the PRISMA statement. All articles published until the 1st of July 2019 in Pubmed were screened with no limitation about years of publication, language or patients’ age. Psychometric properties data were analysed according to the OMERACT Filter methodology version 2.1.ResultsThe literature search identified 91 studies. Face validity was reported in all the articles retrieved, in which the PGA was used alone or as part of composite indices (SRI, SFI, LLDAS, DORIS remission criteria). Content validity was reported in 89 studies. Construct validity was demonstrated by a good correlation (r≥0.50) between the PGA with the SLEDAI (12 studies), SLAM (4 studies), LAI, BILAG and ECLAM (2 studies each). Criterion validity was assessed exploring the PGA correlation with quality of life measurements, biomarkers levels and treatment changes in 28 studies, while no study has evaluated correlation with damage. A good responsiveness for PGA was shown in 8 studies. A high variability in scales was found, causing a wide range of reliability (ICC=0.67-0.98).ConclusionPGA 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.

Laboratory investigation results influence Physician’s Global Assessment (PGA) of disease activity in SLE

2020 ◽  
pp. annrheumdis-2019-216753 ◽  
Author(s):  
Cynthia Aranow ◽  
Anca Askanase ◽  
Shereen Oon ◽  
Molla Huq ◽  
Alicia Calderone ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Global Assessment ◽  
Intraclass Correlation ◽  
Physician Global Assessment ◽  
Systemic Lupus ◽  
Laboratory Test Results ◽  
Laboratory Results ◽  
The Impact

ObjectiveTo evaluate the impact of laboratory results on scoring of the Physician Global Assessment (PGA) of disease activity in systemic lupus erythematosus.MethodsFifty clinical vignettes were presented via an online survey to a group of international lupus experts. For each case, respondents scored the PGA pre and post knowledge of laboratory test results (pre-lab and post-lab PGAs). Agreement between individual assessors and relationships between pre-lab and post-lab PGAs, and PGAs and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) were determined. Respondents were also asked about factors they incorporate into their PGA determinations.ResultsSixty surveys were completed. The inter-rater PGA reliability was excellent (pre-lab intraclass correlation coefficient (ICC) 0.98; post-lab ICC 0.99). Post-lab PGAs were higher than pre-lab PGAs: median (IQR) pre-lab PGA 0.5 (1.05), post-lab PGA 1 (1.3) (p<0.001), with a median (IQR) difference of 0.2 (0.45). In general, all abnormal labs including elevated anti-double stranded DNA antibody level (dsDNA) and low complement impacted PGA assessment. Cases with weakest correlations between pre-lab and post-lab PGA were characterised by laboratory results revealing nephritis and/or haematological manifestations. Both pre-lab and post-lab PGAs correlated with SLEDAI-2K. However, a significantly stronger correlation was observed between post-lab PGA and SLEDAI-2K. Multiple factors influenced PGA determinations. Some factors were considered by an overwhelming majority of lupus experts, with less agreement on others.ConclusionsWe found excellent inter-rater reliability for PGAs in a group of international lupus experts. Post-lab PGA scores were higher than pre-lab PGA scores, with a significantly stronger correlation with the SLEDAI-2K. Our findings indicate that PGA scoring should be performed with knowledge of pertinent laboratory results.

Associations between physicians’ global assessment of disease activity and patient-reported outcomes in patients with systemic lupus erythematosus: A longitudinal study

Lupus ◽  
2021 ◽  
pp. 096120332110279
Author(s):  
Worawit Louthrenoo ◽  
Nuntana Kasitanon ◽  
Eric Morand ◽  
Rangi Kandane-Rathnayake
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Global Assessment ◽  
Patient Reported Outcomes ◽  
Global Rating ◽  
Physician Global Assessment ◽  
Systemic Lupus ◽  
Patient Reported ◽  
Longitudinal Associations

Objective To determine longitudinal associations between Physician Global Assessment (PGA) and patient-reported outcomes (PROs) in patients with systemic lupus erythematosus (SLE). 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 their global rating of change (GRC) at each visit. PGA, SLEDAI-2K and SLE Flare Index (SFI) were also captured on all visits. Generalised estimating equations (GEE) methods were used to examine longitudinal associations of PGA with PROs and clinical indicators. Results 337 patients were followed for a median [IQR] of 3.2 [1.6, 3.4] years (2,059 visits). High PGA (>1) was strongly associated with high SLEDAI-2K scores, the presence of flares and poor PROs. Odd ratios (OR) [95% CI] of PGA > 1 in patients with SLEDAI-2K >4 & <10 and SLEDAI-2K ≥10, compared to SLEDAI-2K ≤ 4, were 3.46 [2.36, 5.08], p < 0.001 and 6.39 [4.30, 9.49], p < 0.001, respectively. OR [95% CI] of PGA > 1 in patients with mild-to-moderate or severe flares were 2.09 [1.62, 2.71], p < 0.001 and 4.42 [3.21, 6.07], p < 0.001, respectively. Mental components of both SLEQOL (mood, self-image) and SF36 (MCS) surveys demonstrated significant associations with high PGA. After adjusting for SLEDAI-2K, one-point increase in PGA was associated with reductions in SLEQOL total score and SF36-MCS by 2.33 (regression coefficient (RC) [95% CI] = −2.33 [−3.77, −0.88], p = 0.002), and 4.16 (RC [95% CI] = −4.16 [−5.19, −3.13], p < 0.001) points, respectively. Associations of some physical components (SLEQOL-symptoms, and SF36-PCS) with PGA attenuated when adjusted for SLEDAI-2K. Patients who rated low scores of GRC, which indicate health deterioration, were twice as likely to have PGA > 1 (OR [95%CI] 1.99 [1.25, 3.16], p = 0.004). Conclusion High PGA was strongly associated with poor mental health, high disease activity and flares. This study confirms the value of PGA as an efficient assessment tool for SLE.

TNF-alpha inhibitors in Systemic Lupus Erythematosus. A case report and a systematic literature review

2013 ◽  
Vol 25 (4) ◽  
pp. 642-645 ◽  
Author(s):  
Marta Mosca ◽  
Chiara Tani ◽  
Maria Elena Filice ◽  
Linda Carli ◽  
Andrea Delle Sedie ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Case Report ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Lupus Erythematosus ◽  
Tnf Alpha ◽  
Systemic Lupus
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