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, Chakravarty E This button displays the currently selected search type. , Lerman RH (PGA), physician global assessment of disease activity (PHGA), C3, C4, and Anti-ds . Criterion validity. Kandane-Rathnayake R, Louthrenoo W, Hoi A, Luo SF, Wu YJ, Chen YH, Cho J, Lateef A, Hamijoyo L, Navarra SV, Zamora L, Sockalingam S, An Y, Li Z, Katsumata Y, Harigai M, Hao Y, Zhang Z, Kikuchi J, Takeuchi T, Basnayake BMDB, Chan M, Ng KPL, Tugnet N, Kumar S, Oon S, Goldblatt F, O'Neill S, Gibson KA, Ohkubo N, Tanaka Y, Bae SC, Lau CS, Nikpour M, Golder V, Morand EF; Asia-Pacific Lupus Collaboration. Construct validity. , Askanase A 215 (FIVE YEARS 146) H-INDEX. FOIA , Jnsen A , Weisman MH. The Physician Global Assessment (PGA) is a visual analogue score that reflects the clinician's judgement of overall SLE disease activity. Gladman DD , Glassman DS Fatigue is independently associated with disease activity assessed using the Physician Global Assessment but not the SLEDAI in patients with systemic lupus erythematosus. Accessibility Copay AG , Cella D. van Vollenhoven RF , Jolly M. Mazur-Nicorici L , Wallace DJ The OMERACT defines an instrument as an outcome measure if it passes the three pillars of evidence: truth (that refers to validity), discrimination (that includes reliability and responsiveness) and feasibility. Physician Global Assessment International Standardisation COnsensus in Systemic Lupus Erythematosus: the PISCOS study . , Magder LS IgM) on attainment PhGA. , Bonithon-Kopp C , Arbab-Zadeh A , Nguyen SC 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. This suggests that the role of the PGA is limited for disease activity assessment when used as a single instrument. 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. , Petri MA , Tugwell P Methods The Author(s) 2020. A good responsiveness for PGA was shown in eight studies. Despite the need for new treatments in CLE . An international panel of 79 SLE experts participated in a three-round Delphi consensus . In this sense, criterion validity of PGA is satisfied when scores correlate with phenomena subsequently influenced by disease activity, such as quality of life measurements (Health-related Quality of Life, 36-item Short Form Health Survey, Functional Assessment of Chronic Illness TherapyFatigue score, Lupus Impact Tracker and LupusPRO), biomarker levels (complement fractions, ESR, autoantibodies), treatment variations and damage assessments (SDI). Methods: This systematic literature review was conducted by two independent reviewers in accordance with the Preferred Reporting Items . HHS Vulnerability Disclosure, Help The last MEDLINE search was performed on 1 July 2019. T2 - A longitudinal study. , Shea BJ , Taghavi-Zadeh S et al. , Kalunian K Genetic linkage has related dysfunction of . , Buyon J Would you like email updates of new search results? The literature search identified 91 studies. Finally, the PGA enables the measurement of disease activity globally compared with a glossary-based index. Barr et al. Touma Z The assessment of PGA responsiveness was performed in 10 studies [4, 23, 50, 58, 7779, 81, 83, 84] using different methods [110]. Different definitions of PGA retrieved through the literature search are reported in Table1. et al. The PGA was integrated in composite indices, including the definition of the LLDAS [12, 13, 29, 34, 37, 39, 40] and remission [29, 37] (Table1). , McGwin G 2014 - 20184 years. MeSH et al. Jesus D 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 . The aim of this systematic literature review is to describe and analyse the psychometric properties of the PGA. SLE has protean and often complex manifestations, necessitating careful clinical assessment. Quimby KR An official website of the United States government. How should lupus flares be measured? 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). Construct validity is the degree to which the PGA relates to other instruments that measure the same concept [18]. 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). , Altman DG Different scores and lengths of visual evaluation were employed: the first was the 010 VAS suggested by Liang et al. , Engle E , Petri M. Thanou A et al. et al. Discrimination refers to whether the score (PGA-VAS) differentiates between situations of interest [18]: discrimination of the PGA measures the ability of the PGA-VAS to report a consistent score where no change in disease activity has occurred (reliability) and to detect a change when a change in disease activity has occurred (sensitivity to change or responsiveness). , Sadovici-Bobeica V , Nelson S In 1988, Liang et al. Int J Environ Res Public Health. We have systematically reviewed all studies about validation of the PGA in SLE. et al. Background/Purpose: The Physician Global Assessment (PGA) is a frequently-used outcome measure in Systemic Lupus Erythematosus (SLE). The official NJDOE Incident Reporting Form, as well as a guide to completing 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 . Schneider M MD globals may vary based on their age, gender, practice setting and experience (number of patients seen per year and years in practice). To determine longitudinal associations between Physician Global Assessment (PGA) and patient-reported outcomes (PROs) in patients with systemic lupus erythematosus (SLE). Epub 2014 Jul 10. Few studies reported on whether serological activity should be incorporated in the PGA. An international panel of 79 SLE experts participated in a three-round Delphi consensus process, in which 41 statements related to the PGA in SLE were . CLOSED ANGLE/ ANGLE CLOSURE GLAUCOMA. sharing sensitive information, make sure youre on a federal official website and that any information you provide is encrypted Convergent validity is fulfilled indirectly in studies where the PGA is used as the gold standard to assess the construct validity of other indices. et al. Liang MH 2022 Sep 20;19(19):11895. doi: 10.3390/ijerph191911895. et al. Federal government websites often end in .gov or .mil. 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. AU - Louthrenoo, Worawit. et al. The PGA was introduced in 1998 by a US Food and Drug Administration panel as the preferred tool to assess and record the severity of disease in clinical studies, and typically rates a patient's disease from 'clear' to 'severe' or 'very severe' [1, 2]. , Piette EW 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. 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]. , Devilliers H Criterion validity also refers to the degree to which an instrument predicts aspects and phenomena occurring in the future [108]. Thanou A, Chakravarty E, James JA, Merrill JT. et al. All articles published through 1 July 2019 in PubMed were screened, with no limitation on year of publication, language or patients' age. Gandhi N In 89 studies [2, 3, 913, 21102] the PGA was used to measure disease activity as a whole, therefore satisfying the content validity criteria. , Urowitz MB PGA responsiveness was used to assess flare [9]: PGA was identified as the gold standard to rate the exacerbation of lupus activity [21, 67, 88], preliminarily defined by a change of 1.0 on a 03 VAS since the last visit. , Aggarwal R Objective Physician's global assessment (PGA) of disease activity is a major determinant of therapeutic decision making. , Cappellazzo G , Bouter LM global automatic chemiluminescence immunoassay analyzer market INTRODUCTION The chemiluminescence immunoassay system employs magnetic particle separation technology, which employs magnetic particles as antibody carriers and allows for even distribution of the carriers in the liquid phase reaction system, resulting in a faster and more effective . Content validity pertains to the degree to which the instrument measures all facets of a construct of interest [20]: this property is satisfied if the PGA is considered able to measure all aspects of disease activity in SLE in a comprehensive way. ECG - correct answer no sleep the night before, meals allowed, no stimulants/tranquilizers for 24-48 hours before. 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 . A new tool -- the Lupus Activity Scoring Tool (LAST) - has been proposed to join the ranks of current disease activity indices. , Jolly M. Mok CC et al. Lead Medical Director heading up the global collaboration with Pfizer for Enbrel trials. 8600 Rockville Pike , Socher SA , Petri M. Iaccarino L Provide oversight to Shared Services Derivatives team supporting RWA operations and production. et al. Conclusion: Because of its dynamic nature, this disease has an unpredictable natural course leading to high . X 20 Physician Global Assessment 10.1136/lupus-2019-lsm.176 . , Sjwall C It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. 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. Mertz P, Piga M, Chessa E, Amoura Z, Voll RE, Schwarting A, Maurier F, Blaison G, Bonnotte B, Poindron V, Fiehn C, Lorenz HM, Korganow AS, Sibilia J, Martin T, Arnaud L. RMD Open. , Hennis A. Jesus D et al. et al. 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 . 2014 Sep-Oct;10(5):309-20. doi: 10.1016/j.reuma.2014.01.012. Systemic lupus erythematosus (SLE) is a multisystem autoimmune rheumatic disease (ARD) characterized by flares and remissions. Ann Rheum Dis 2 Isenberg DA, Allen E, Farewell V, et al. 25 (FIVE YEARS 8) Latest Documents Most Cited Documents Contributed Authors Related Sources Related Keywords Latest Documents; Most Cited Documents; Contributed Authors; Related Sources; BICLA responders had fewer lupus-related serious . PGA0.3. 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. . A prospective cohort study, Validity and reliability of retrospective assessment of disease activity and flare in observational cohorts of lupus patients, A novel lupus activity index accounting for glucocorticoids: SLEDAI-2K glucocorticoid index, Low disease activityirrespective of serologic status at baselineassociated with reduction of corticosteroid dose and number of flares in patients with systemic lupus erythematosus treated with belimumab: a real-life observational study, Definition and initial validation of a lupus low disease activity state (LLDAS), A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS), Prolonged remission in Caucasian patients with SLE: prevalence and outcomes, 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus, PRISMA Group. Laboratory investigation results influence Physicians Global ssessment (PGA) of disease activity in SLE. , Landis RC , Klein-Gitelman MS et al. Meta-analysis of the studies reporting data concerning the construct validity between the PGA and SLEDAI. No study has evaluated the correlation of PGA with damage measures. On stratifying the results by individual clinician, values ranged from 0.61 to 0.90, except for those reported by . 3TR (Taxonomy, Treatment, Targets and Remission) Systemic Lupus Erythematosus Study Protocol 2 The correlation with the SLEDAI was determined in 12 studies (Fig. Arthritis Res Ther. Patient global assessment (PGA) is one of the most widely used PROs in RA practice and research and is included in several composite scores such as the 28-joint Disease Activity Score (DAS28). These results enabled its use as a gold standard for assessing flare and defining flare severity in several studies [21, 67, 88]. The literature search identified 93 articles, and 12 additional articles were retrieved from the reference list of those publications. The 4-point PGA (0, no flare; 1, mild; 2, moderate; 3, severe) showed the lowest IRR in assessing flare (ICC=0.18) compared with the BILAG-2004 (ICC=0.54) and SFI (ICC=0.21) [65]. . 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. Methods This SLR was conducted by two independent reviewers in accordance with the PRISMA statement. Thank you for submitting a comment on this article. , Kalunian K The last EULAR/ACR recommendations recommended use of the PGA in the routine monitoring of SLE [16]. Diet and Systemic Lupus Erythematosus (SLE): From Supplementation to Intervention. Cloud, mobility, security, and more. Your recommendations as to what might or should be done in relation to various issues observed. 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]. However, no precise guidelines exist regarding the optimal use of the PGA in SLE, such as the adequate length of the VAS, the presence of anchored values, the incorporation of laboratory data and the time frame of assessment. , Urowitz MB. FitzGerald and Grossman [10] found a good interRR in a retrospective assessment of the PGA (=0.79). Over the years, PGA-IGA scales were modified for the purpose of clinical settings and thus present a diversity in the number of response options (4 to 10 points), the response options label and the . Thanou A Arriens C Mina R Funding: The study was funded through the training Bursary Programme 2019 of the SLEuro European Lupus Society. SLE3. Supervise the development of junior medical affairs staff . 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]. Please enable it to take advantage of the complete set of features! The PGA also showed good predictive validity, as it correlated significantly with measures of future outcomes, such as quality of life or laboratory exams, but no study has currently evaluated its correlation with measures of damage. They proposed a physician global score on a 10cm visual analogue scale (VAS) to be used as a gold standard to compare six disease activity instruments [4]. The intrarater reliability (intraRR) is the ability to provide consistent scores in a stable population by the same assessor over time. Even though the PGA showed optimal reliability, a very low interRR for flare using the PGA (ICC=0.18) was found in a single study [65] compared with that of the BILAG (ICC=0.54) or SFI (ICC=0.21). [8] and adopted in childhood SLE; the most common tool (the 03 VAS) was developed [68] to capture the concept of flare and is measured on a 3cm VAS in the SRI [3] and a 10cm VAS in the SFI [10, 104], but other scores (02, 04, 05, 07) [11, 53, 78, 80, 86, 87] and lengths (8cm, 15cm) [10, 8284] have also been used. Each study was examined in order to extract psychometric property data on the PGA according to the OMERACT Filter methodology version 2.1 [18]. and transmitted securely. While specific studies remain to be performed to determine the optimal method for scoring the PGA, this literature search showed that the most adopted form of PGA was a 10cm 03 VAS with anchors (0, none; 1, mild; 2, moderate; 3, severe activity) [3]. The PGA intraRR was assessed in three studies [10, 68, 94] and ranged from 0.55 [68] to 0.88 [10]. 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]. The aim of this systematic literature review (SLR) is to describe and analyse the psychometric properties of PGA. Petri M Your comment will be reviewed and published at the journal's discretion. Physician's Global Assessment Scale (PGA) or Investigator's Global Assessment Scale (IGA) measures disease status in a broad range of diseases. 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]. , Birmingham DJ The patients were diagnosed as having the following disorders: scleroderma (n = 27), dermatomyositis (n = 11), systemic lupus erythematosus (SLE) (n = 22), MCTD (n = 8), and RP without evidence of underlying CTD (n = 38). , Saad-Magalhes C , Gomez A 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. Face validity is satisfied when the instrument is considered able to capture what it should capture (i.e. et al. 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. The responsiveness of the PGA was assessed through different methods [109, 113] showing a high sensitivity for detecting clinical variations [84]. BATCH RUBY INTENSIVE REVIEWRTRMF 3. Truth refers to whether the measure provided by the scores is able to measure what was intended [18]. Improving patient pathways for systemic lupus erythematosus: a multistakeholder pathway optimisation study. SFI, LLDAS, SRI, Definitions of Remission in Systemic Lupus Erythematosus remission criteria) [3, 5, 10, 1315, 104]. , Stavrakis S The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). , Voskuyl A , Jolly M. Antony A , Smiley A. Askanase AD . Data regarding divergent validity are lacking for the PGA. A good responsiveness for PGA was shown in eight studies. Trusted for over 30 years to provide and transform technology into complete solutions that advance the value of IT. Retrieved papers were selected with no limitation on the year of publication, language or patients age. Ruiz-Irastorza G The Physician Global Assessment (PGA) of treatment response measures the overall response to treatment as assessed by the physician. BICLA is a validated composite global measure of SLE disease activity including SLEDAI-2K, CLASI-A, OCS dosage reduction, and patient-reported outcomes. European League Against Rheumatism. , Urowitz MB Three studies evaluated the association between PGA scores and treatment changes: PGA correlated negatively with adherence to treatment assessed through an item scale (r=0.31, P=0.11) [34]; clinically defined mild and moderate flares had a higher disease activity by the PGA (P<0.001) than those defined as mild/moderate flare only by medication changes [55]; PGA scores were associated positively with response to belimumab treatment (P=0.039) [43]. The aim of this systematic review is to describe and analyse the measurement properties of the PGA, including the validity, reliability, responsiveness and feasibility. Reviews and case series with fewer than five patients were excluded. Physician's Global Assessment (PGA) score 1.0 on a 0 to 3 visual analog scale. et al. Moreover, there is uncertainty as to whether the best timing of assessment is prior to or after reviewing laboratory exams [26]. , Subach RB , Kiani AN Touma Z et al. , Ravelli A Construct validity is shown by the good correlation observed with the SLEDAI, BILAG, SLAM, LAI and ECLAM [10, 23, 24, 26, 28, 29, 35, 54, 68, 76, 84, 99]. 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. Oxford University Press is a department of the University of Oxford. 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. The visual analog scale (VAS)-based assessments, SELENA SLE Disease Activity Index (SLEDAI) Physician's Global Assessment (SSPGA) and Lupus Foundation of America-Rapid Evaluation of Activity in Lupus (LFA-REAL), can be used to assess common trial end points for systemic lupus erythematosus (SLE), according to study results published in Lupus Science & Medicine. , Magder L , Vogel-Claussen J Epub 2014 Apr 11. Whenever papers reported duplicate data, the most recent article was selected. [84] expressed the sensitivity in PGA scoring with the standardized response mean (SRM), demonstrating a very large effect size (ES=2.23) [110]. , Annapureddy N , Brunetta P van Vollenhoven R 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). The PGA is a valid instrument but has variable reliability; its scoring should be standardized. It should be noted that the PGA correlates with several other instruments that measure disease activity. No data were found regarding the feasibility of the PGA. Lai J-S [2, 21, 24] recommended PGA assessment prior to reviewing serological data, based only on the clinical visit. Navarra SV 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 Systemic Lupus Activity Measure-revised, the Mexican Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and a modified SLEDAI-2K are adequate instruments to measure disease activity in systemic lupus erythematosus. The search strategy for SSc-related publications identified 75 citations . 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]. , Klein-Gitelman MS Of note, it is not trivial that we found a good convergent validity with other instruments (SLEDAI, BILAG, LAI, SLAM and ECLAM) [10, 23, 24, 26, 28, 29, 35, 54, 68, 76, 84, 99]. Ensure second line of defense Derivatives RWA reviews are performed consistently and . Brunner HI Gordon C 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]. The aim of this systematic literature review is to describe and analyse the . SLE is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. , Kraag GR , Mina R In 32 studies, disease activity measured by PGA was compared with changes in laboratory markers, with the aim of correlating clinical and serological features [9, 21, 30, 32, 34, 3739, 44, 45, 48, 49, 55, 5861, 63, 64, 66, 67, 69, 71, 74, 75, 82, 86, 89, 9194]. Results of a large, multicentric, nationwide study, American College of Rheumatology provisional criteria for global flares in childhood-onset systemic lupus erythematosus, A cross-sectional study of hydroxychloroquine concentrations and effects in people with systemic lupus erythematosus, Inactive disease and remission in childhood-onset systemic lupus erythematosus, Preliminary criteria for global flares in childhood-onset systemic lupus erythematosus, Systemic lupus erythematosus in a multiethnic US cohort, XXXVII: association of lymphopenia with clinical manifestations, serologic abnormalities, disease activity, and damage accrual, Systemic lupus erythematosus in a multiethnic cohort (LUMINA): XXIX. , McGuire JL. , Anderson N Psychometric properties of FACIT-Fatigue in systemic lupus erythematosus: a pooled analysis of three phase 3 randomised, double-blind, parallel-group controlled studies (BLISS-SC, BLISS-52, BLISS-76). Sullivan KE , Matos A This systematic literature review was conducted by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. et al. Some may be a consequence of therapy and others may be . (PGA) scoring of disease activity in systemic lupus erythematosus (SLE). PGA is a simple instrument and the result is easily understood. inflammation (duration and severity of morning stiffness as measured by BASDAI). 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). , Wallace DJ 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). Several definitions of minimum clinically important difference were retrieved: in the SRI-4, a significant worsening was defined as an increase of >10% on the PGA-VAS [111], corresponding to 0.3 points from baseline; Touma et al. Content validity was reported in 89 studies. , Garabajiu M The SRI is a validated SLE disease activity instrument used to detect clinically meaningful improvement of disease in SLE clinical trials. doi: 10.1136/lupus-2022-000700. A PGA >1 was predictive of polymorphic light cutaneous eruption (P=0.02) [59] and correlated negatively with LLDAS attainment [37]. , Siega-Riz AM The quantification of reliability is expressed by a correlation coefficient. , Arora S , Francis S government site. It operates in Albuquerque, and New Mexico. 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. Karol DE Parodis I Objective Existing methods for grading lupus flares or improvement require definition-based thresholds as increments of change. , Chatzidionysiou K et al. J Clin Med. Impact of anti-SARS-CoV-2 antibodies of different isotypes (IgA, IgG, IgM) on attainment of PGA . In two studies, the PGA-VAS was used to assess concepts other than disease activity: disease severity [4] and patients compliance with treatments [103]. , Burlingame RW 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. Thus the development of a comprehensive index for assessing disease activity still represents one of the most important challenges in SLE [7].

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