Evidence map›Paper›PMID 28388813›Full record

ArticleArthritis care & research2018

Study of Flare Assessment in Systemic Lupus Erythematosus Based on Paper Patients.

D Isenberg, J Sturgess, E Allen, C Aranow, A Askanase, B Sang-Cheol, S Bernatsky, I Bruce, J Buyon, R Cervera and 29 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Arthritis care & research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
  4. Article
  5. Review
  6. Article
  7. Flares in patients with systemic lupus erythematosus.Rheumatology (Oxford, England) · 2021
    Observational
  8. Article
  9. Article
  10. Article
  11. Review
  12. SLE: reconciling heterogeneity.Lupus science & medicine · 2019
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

39 authors.

D IsenbergUniversity College London, London, UK.
J SturgessThe Hospital For Tropical Diseases, London, UK.
E AllenThe Hospital For Tropical Diseases, London, UK.
C AranowFeinstein Institute for Medical Research, Manhasset, New York.
A AskanaseColumbia University, New York, New York.
B Sang-CheolHanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.
S BernatskyMcGill University, Quebec, Ontario, Canada.
I BruceThe University of Manchester, Central Manchester University Hospitals NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK.
J BuyonNew York School of Medicine, New York.
R CerveraUniversitat de Barcelona, Barcelona, Spain.
A ClarkeCumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Mary Anne DooleyUniversity of North Carolina, Chapel Hill.
P FortinUniversité Laval, Quebec City, Québec, Canada.
E GinzlerDownstate Medical Center Rheumatology, Brooklyn, New York.
D GladmanKrembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
J HanlyNova Scotia Rehabiliation Center, Halifax, Nova Scotia, Canada.
M InancIstanbul University, Istanbul, Turkey.
S JacobsenRigshospitalet, Copenhagen, Denmark.
D KamenMedical University of South Carolina, Charleston, UK.
M KhamashtaKing's College London, London, UK.
S LimEmory University, Atlanta, Georgia.
S ManziAllegheny Health Network, Pittsburgh, Pennsylvania.
O NivedLund University, Lund, Sweden.
C PeschkenUniversity of Manitoba, Winnipeg, Manitoba, Canada.
M PetriJohns Hopkins University, Baltimore, Maryland.
K KalunianUniversity of California at San Diego, Chicago, Illinois.
A RahmanUniversity College London, London, UK.
R Ramsey-GoldmanNorthwestern University, Feinberg School of Medicine, Chicago, Illinois.
J Romero-DiazInstituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico.
G Ruiz-IrastorzaHospital Universitario Cruces and University of the Basque Country, Barakaldo, Spain.
J Sanchez-GuerreroMount Sinai Hospital and University Health Network and University of Toronto, Toronto, Ontario, Canada.
K SteinssonLandspitali University Hospital, Reykjavik, Iceland.
G SturfeltLund University, Lund, Sweden.
M UrowitzKrembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
R van VollenhovenKarolinska University Hospital, Solna, Sweden.
D J WallaceUniversity of California at Los Angeles, Scotland, UK.
A ZomaHairmyres Hospital, East Kilbride, Scotland, UK.
J MerrillOklahoma Medical Research Foundation, Oklahoma City, UK.
C GordonCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine the level of agreement of disease flare severity (distinguishing severe, moderate, and mild flare and persistent disease activity) in a large paper-patient exercise involving 988 individual cases of systemic lupus erythematosus.

methodsA total of 988 individual lupus case histories were assessed by 3 individual physicians. Complete agreement about the degree of flare (or persistent disease activity) was obtained in 451 cases (46%), and these provided the reference standard for the second part of the study. This component used 3 flare activity instruments (the British Isles Lupus Assessment Group [BILAG] 2004, Safety of Estrogens in Lupus Erythematosus National Assessment [SELENA] flare index [SFI] and the revised SELENA flare index [rSFI]). The 451 patient case histories were distributed to 18 pairs of physicians, carefully randomized in a manner designed to ensure a fair case mix and equal distribution of flare according to severity.

resultsThe 3-physician assessment of flare matched the level of flare using the 3 indices, with 67% for BILAG 2004, 72% for SFI, and 70% for rSFI. The corresponding weighted kappa coefficients for each instrument were 0.82, 0.59, and 0.74, respectively. We undertook a detailed analysis of the discrepant cases and several factors emerged, including a tendency to score moderate flares as severe and persistent activity as flare, especially when the SFI and rSFI instruments were used. Overscoring was also driven by scoring treatment change as flare, even if there were no new or worsening clinical features.

conclusionGiven the complexity of assessing lupus flare, we were encouraged by the overall results reported. However, the problem of capturing lupus flare accurately is not completely solved.

Indexed as

Decision Support TechniquesMedical RecordsSurveys and QuestionnairesClinical CompetenceConsensusDisease ProgressionHumansLupus Erythematosus, SystemicObserver VariationPredictive Value of TestsReproducibility of ResultsSeverity of Illness Index

Identifiers

PMID28388813
PMCPMC5767751

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.