Abstract
ObjectivesThe aim of this study was to evaluate the discriminant capability of the patient acceptable symptom state (PASS) according to disease activity, in a cohort of Italian patients affected by systemic Lupus erythematosus (SLE).MethodsConsecutive SLE patients were enrolled. At each visit, the patients underwent a complete physical examination and the clinical/laboratory data were collected in a standardized, computerized, and electronically-filled form. The evaluation of serum complement C3 and C4 levels and determination of autoantibodies was obtained. Disease activity was assessed with the SLEDAI-2K and ECLAM, while chronic damage was measured with the SLICC. Finally, PASS was assessed in all patients by asking to answer yes or no to a single question.ResultsOne hundred sixty-five patients were enrolled (M/F 12/153; mean age 40.4±11.8 years, mean disease duration 109.1±96.2 months). No patients refused to answer, suggesting the acceptability of PASS. A total of 80% of patients rated their state as acceptable. The patients with an acceptable status had significantly lower mean SLEDAI-2K and ECLAM scores than the others [1.8±2.7 versus 3.4±2.3(P=0.004); 0.7±0.9 versus 1.4±1.1(P=0.0027)]. No significant differences were observed when considering chronic damage, evaluated with SLICC.ConclusionsIn the clinical practice, SLE patients assessment performed by using complex disease activity indices such as SLEDAI-2K and ECLAM, could be time consuming. In our study, for the first time, we used PASS, a quick and easily comprehensible tool, to evaluate the patients’ status, this single question seems to be able to discriminate patients with different disease activity, especially when this is determined by musculoskeletal involvement.
Highlights
Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease, involving genetic and environmental factors, characterized by a wide range of autoantibodies and clinical manifestations [1,2,3,4,5,6,7,8,9,10]
Monitoring of disease activity is an important aspect in the management of SLE patients, as recently pointed out in a core-set of recommendations proposed by the European League Against Rheumatism (EULAR) [11]
The main demographic, clinical and laboratory features of SLE patients are reported according with the answer to patient acceptable symptom state (PASS)
Summary
Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease, involving genetic and environmental factors, characterized by a wide range of autoantibodies and clinical manifestations [1,2,3,4,5,6,7,8,9,10]. Many indices have been developed and validated to measure disease activity in SLE patients, such as the Systemic Lupus Erythematosus Disease Activity Index. 2000 (SLEDAI-2K) and the European Consensus Lupus Activity Measurement (ECLAM) [12,13]. Flare is another outcome measure that identifies patients with a worsening of disease activity. In order to identify patients with a disease course characterized by a persistent status of activity, the concept of persistently active disease (PAD) was proposed [16,17,18]
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