, Schur PH. et al. 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]. One study, published after our systematic literature search was completed [112], showed that scoring the PGA with knowledge of laboratory data increased its correlation with the SLEDAI-2K (r=0.79) compared with without knowledge of laboratory results (r=0.67). The content can vary and relates either to global health (e . http://oml.eular.org/glossary (31 January. Deconstruction of the safety of estrogen in lupus erythematosus national assessment-systemic lupus erythematosus disease activity index flare index, Effect of raloxifene on disease activity and vascular biomarkers in patients with systemic lupus erythematosus: subgroup analysis of a double-blind randomized controlled trial, Omega-3 in SLE: a double-blind, placebo-controlled randomized clinical trial of endothelial dysfunction and disease activity in systemic lupus erythematosus, Erythrocyte sedimentation rate is a predictor of renal and overall SLE disease activity, Characterization of clinical photosensitivity in cutaneous lupus erythematosus, Validation of the systemic lupus erythematosus responder index for use in juvenile-onset systemic lupus erythematosus, Depressive symptoms and associated factors in systemic lupus erythematosus, Validation of the Portuguese simple measure of impact of lupus erythematosus in youngsters (SMILEY) in Brazil, Anti-C1q antibodies have higher correlation with flares of lupus nephritis than other serum markers, Performance of anti-C1q, antinucleosome, and anti-dsDNA antibodies for detecting concurrent disease activity of systemic lupus erythematosus, An assessment of disease flare in patients with systemic lupus erythematosus: a comparison of BILAG 2004 and the flare version of SELENA, Noncalcified coronary plaque in systemic lupus erythematosus, Decreases in anti-double-stranded DNA levels are associated with concurrent flares in patients with systemic lupus erythematosus, Validity and reliability of lupus activity measures in the routine clinic setting, Clinical predictors of response and discontinuation of belimumab in patients with systemic lupus erythematosus in real life setting. It estimates how similar a given patients scores were at the two visits. , Holland M , Raeisi A independently selected the articles, initially on the basis of titles and abstracts, then, if necessary, on the full texts, an eligibility assessment was performed independently in a blinded standardized manner. doi:10.1136/ rmdopen-2017-000578 Prepublication history and 10- Medical- Surgical- Nursing- Intensive- Review et al. Physician's Global Assessment in Psoriatic Arthritis: A Multicenter In only one study [4], was PGA sensitivity assessed comparing the change with an anchor [109], represented by the treatment sensitive index: PGA sensitivity was found to be between that of the BILAG (highest sensitivity) and the SLEDAI (lowest sensitivity). Moher D Provide oversight to Shared Services Derivatives team supporting RWA operations and production. 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 . Correlations with other instruments measuring similar constructs should typically demonstrate a coefficient (r) 0.50 [106]. Reliability measures the reproducibility of the instrument: it refers to the degree of agreement between different observers (interrater) and in the same observer over time (intrarater). , Dietzmann K 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. The https:// ensures that you are connecting to the In conclusion, the PGA was demonstrated to be a valid, responsive and feasible instrument, but its reliability was strongly impacted by the scale adopted, suggesting the need for standardization in its scoring. Moreover, a difference between the interRR of the PGA assessed by an untrained physician (0.50.63) and a trained investigator (0.790.81) was found, suggesting the need for PGA scoring training or standardization [36]. Importance: In dermatology, the development of objective, standardized quality measures that can be used in a clinical setting is important to be able to respond to the needs of payers and credentialing and licensure bodies and to demonstrate dermatologic value. 2022 Mar 14;24(1):70. doi: 10.1186/s13075-022-02756-3. Navarra SV Int J Environ Res Public Health. Nehring J Patient global assessment in measuring disease activity in rheumatoid Physician Global Assessment International Standardisation COnsensus in In the second column, the definitions were reported according to the VAS used in the study. MeSH Patient-reported outcomes (PROs) reflect the patient's perspective and are used in rheumatoid arthritis (RA) routine clinical practice. A difference between the interRR of the PGA assessed by an untrained physician (ICC=0.50.63) or a trained investigator (ICC=0.790.81) was found [36]. Use of Physician Global Assessment (PGA) in Systemic lupus - medRxiv Mayara Torres Silva de Oliveira, MD, MBA on LinkedIn: #medicinanuclear , Urowitz MB , Socher SA , Bonithon-Kopp C , Kosinski M Laboratory investigation results influence Physicians Global ssessment (PGA) of disease activity in SLE. Your recommendations as to what might or should be done in relation to various issues observed. et al. Objectives Remission in systemic lupus erythematosus (SLE) is defined through a combination of 'clinical SLE Disease Activity Index (cSLEDAI)=0', 'physician's global assessment (PGA) <0.5 . CareerBuilder TIP. Mina R Patient and Physician Global Assessments of Disease Status in Systemic Oxford Textbook of. 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]. SLE has protean and often complex manifestations, necessitating careful clinical assessment. Mokkink LB Intoduction to X 20 - Physician Global Assessment Fatigue is independently associated with disease activity assessed using the Physician Global Assessment but not the SLEDAI in patients with systemic lupus erythematosus. A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [17], searching for articles reporting on the use of PGA in SLE. et al. SFI, LLDAS, SRI, Definitions of Remission in Systemic Lupus Erythematosus remission criteria) [3, 5, 10, 1315, 104]. Chaigne B Psychometric properties data were analysed according to the OMERACT Filter methodology version 2.1. , Liberati A , Maxwell LJ 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. An assessment of disease flare in patients with systemic lupus erythematosus: a comparison of BILAG 2004 and the flare version of SELENA. Moreover, there is uncertainty as to whether the best timing of assessment is prior to or after reviewing laboratory exams [26]. 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). , Gladman DD , Subach RB Thanou A, Chakravarty E, James JA, Merrill JT. Objective Physician's global assessment (PGA) of disease activity is a major determinant of therapeutic decision making. Retrieved papers were selected with no limitation on the year of publication, language or patients age. Of note, the literature search revealed heterogeneous definitions of physician assessment of disease activity other than the PGA (physician global assessment [4, 70, 73], physician overall assessment [85]). 1 2. IgM) on attainment PhGA. Genetic linkage has related dysfunction of . 2022 Jan 11;11(2):340. doi: 10.3390/jcm11020340. , Alunno A , Matos A The responsiveness of the PGA is the ability to detect worthwhile variations in disease activity over time, measuring worsening or improvements in SLE disease status. Criterion validity also refers to the degree to which an instrument predicts aspects and phenomena occurring in the future [108]. Construct validity was demonstrated by a good correlation (r0.50) between the PGA with the SLEDAI (12 studies), SLAM (4 studies), LAI, BILAG and ECLAM (2 studies each). The interRR was assessed in seven studies [4, 10, 11, 36, 65, 68, 94], showing values ranging from 0.67 [68] to 0.96 [94]. , Magder L Disclaimer. Use of Physician Global Assessment in systemic lupus erythematosus: a , Chan KL , Chakravarty E van Vollenhoven R . 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]. PGA0.3. SLE231 Hydrology and Water Resources Management: Excursion or Virtual Tour sharing sensitive information, make sure youre on a federal All versions are validated and used by lupus researchers for clinical and research purposes. 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 . , Ravelli A Nevertheless, despite the fact that the PGA was considered the reference in 39 studies involving other indices, it was used as the sole instrument in only 2 of them. 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). , Arora S Face validity is satisfied when the instrument is considered able to capture what it should capture (i.e. et al. , Sayedbonakdar Z , Petri MA , Bertsias G , Beaumont JL According to the authors, this difference was probably due to the greater familiarity of the physicians with the BILAG-2004 index. In Fatemi et al. Published by Oxford University Press on behalf of the British Society for Rheumatology. MD globals may vary based on their age, gender, practice setting and experience (number of patients seen per year and years in practice). , James JA , Tugwell P [8] suggested the need for a disease activity instrument that would be valid, reliable and sensitive to change. , Mosca M X 20 sentence examples within Physician Global Assessment. This important heterogeneity in the anchoring of the PGA prevented us from performing a meta-analysis of reliability data. It does not provide a predefined or limited list of disease manifestations or organ systems, thus allowing one to capture all the heterogeneous aspects of SLE disease activity. , Wallace DJ Visual Analog Scale Assessments Can Reliably Assess Disease Severity in SLE Construct validity. disease activity in SLE, with the Physician Global Assessment (PGA) being the only one included in the updated EULAR recommendations for the management of SLE.11. allergy hx phenothiazines, cns depressants and stimulants withheld 48 hours prior. If you have a published paper from this period that does not appear on this list, please contact Sue Marone, who will add it to next week's collection. Aranow C The SRI is a composite instrument comprised of the SELENA-SLE Disease Activity Index [SELENA-SLEDAI], Physician Global Assessment (PGA) and British Isles Lupus Assessment Group (BILAG) 2004. The Physician Global Assessment International Standardisation COnsensus in Systemic Lupus Erythematosus (PISCOS) study aimed to obtain an evidence-based and expert-based consensus standardisation of the Physician Global Assessment (PGA) scoring of disease activity in systemic lupus erythematosus (SLE). How should lupus flares be measured? Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of multifactorial origin that can affect any organ or organ system, resulting in a broad spectrum of clinical manifestations ranging from dermatological involvement to multi-organ failure with episodes of relapses and remissions. et al. In this systematic review we have analysed the measurement properties of the PGA, including the validity, reliability, responsiveness and feasibility. , Trendelenburg M Randomized MMF Withdrawal in Systemic Lupus Erythematosus (SLE) - Full , Andreoli L This button displays the currently selected search type. ECG - correct answer no sleep the night before, meals allowed, no stimulants/tranquilizers for 24-48 hours before. , Garabajiu M The aim of this systematic literature review is to describe and analyse the psychometric properties of the PGA. , Sjwall C , Su J An international panel of 79 SLE experts participated in a three-round Delphi consensus . The last MEDLINE search was performed on 1 July 2019. Whenever papers reported duplicate data, the most recent article was selected. , Voskuyl A PDF Physician global assessments for disease activity in rheumatoid Different scores and lengths of visual evaluation were employed: the first was the 010 VAS suggested by Liang et al. A multi-item Physician Global Assessment scale to assess psoriasis RMD Open 2018;4:e000578. Presence of at least one of the following items of serological evidence of active SLE or biological variables predictive of Type 1 Interferon (IFN-1) high signature (in a Screening sample as measured by central laboratory): Newark, New Castle, USA, March 03, 2023 (GLOBE NEWSWIRE) -- The global complement-targeted therapeutics market is expected to grow at a CAGR of 8.9% from 2022 to 2030, owing to the rising . et al. , Magder L Supervise the development of junior medical affairs staff . PGA is a simple instrument and the result is easily understood. Measuring disease activity in adults with systemic lupus erythematosus et al. Twenty-nine studies [25, 31, 3439, 41, 43, 48, 49, 5355, 59, 6164, 74, 75, 81, 82, 86, 92, 93, 96, 97] have assessed criterion validity of the PGA (Table2). Vashisht P In the last 30years, more than a dozen scores have been derived to assess disease activity in SLE, but not all of these have proven to be valid and reliable tools. Criterion validity is defined as the degree to which the scores of an instrument adequately reflect the truth in the form of a gold standard [107]. Mahler M et al. The following search strategy was used through MEDLINE via PubMed: (((lupus erythematosus, systemic[MeSH Terms] OR (lupus[TIAB] AND erythematosus[TIAB] AND systemic[TIAB]) OR systemic lupus erythematosus[TIAB] OR (systemic[TIAB] AND lupus[TIAB] AND erythematosus[TIAB]))) OR SLE[TIAB]) AND (physician global assessment[TIAB] OR PGA[TIAB]).
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