Rhubarb and Reliability — A Jane Austen View of Systemic Lupus Erythematosus

Abstract

It is a truth universally acknowledged that a rheumatologist in possession of good sense draws comfort from confirming his or her impression about the degree of activity of a patient with systemic lupus erythematosus (SLE) by using a reliable disease activity index and appropriate laboratory investigation. From the mid-1950s to the mid-1980s, about 60 different disease activity indices were reported for SLE1. These indices were all global scores and none of them was ever shown to be reliable, validated, or sensitive to change. From the 1980s onward, however, considerable thought by several groups went into improving the quality of activity indices, with considerable effort made to demonstrate their validity, reliability, and sensitivity to change2. There has been a great debate as to whether as complex a disease as SLE can be captured by a simple global activity index. The global score has the attraction of simplicity and makes good sense if, for example, a new antibody test has been developed, e.g., an anti-rhubarb antibody that is … E-mail: d.isenberg{at}ucl.ac.uk