International consensus for a definition of disease flare in lupus

Author:

Ruperto N1,Hanrahan LM2,Alarcón GS3,Belmont HM4,Brey RL5,Brunetta P6,Buyon JP7,Costner MI8,Cronin ME9,Dooley MA10,Filocamo G1,Fiorentino D11,Fortin PR12,Franks AG7,Gilkeson G13,Ginzler E14,Gordon C15,Grossman J16,Hahn B16,Isenberg DA17,Kalunian KC18,Petri M19,Sammaritano L20,Sánchez-Guerrero J21,Sontheimer RD22,Strand V11,Urowitz M12,von Feldt JM23,Werth VP2324,Merrill JT25

Affiliation:

1. Gaslini Pediatria II, Reumatologia, PRINTO, Genova, Italy

2. Lupus Foundation of America, Inc., Washington, DC, USA

3. University of Alabama at Birmingham, Birmingham, AL, USA

4. New York University Hospital for Joint Diseases, New York, NY, USA

5. University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA

6. Genentech, San Francisco, CA, USA

7. New York University School of Medicine, New York, NY, USA

8. UT Southwestern Medical Center, Dallas, TX, USA

9. Medical College of Wisconsin, Milwaukee, WI, USA

10. University of North Carolina at Chapel Hill, USA

11. Stanford University School of Medicine, Stanford, CA, USA

12. Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada

13. Medical University of South Carolina, Charleston, SC, USA

14. State University of New York Downstate Medical Center, Brooklyn, NY, USA

15. University of Birmingham Medical School, Edgbaston, Birmingham, UK

16. University of California at Los Angeles, Los Angeles, CA, USA

17. University College London, Bloomsbury, London, UK

18. University of California, San Diego School of Medicine, La Jolla, CA, USA

19. Johns Hopkins Medical Institutions, Baltimore, MD, USA

20. Hospital for Special Surgery, New York, NY, USA

21. Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán México, Distrito Federal, México

22. University of Utah School of Medicine, Salt Lake City, UT, USA

23. University of Pennsylvania School of Medicine, Philadelphia, PA, USA

24. Philadelphia VA Medical Center, Philadelphia, PA, USA

25. Oklahoma Medical Research Foundation, Oklahoma City, OK, USA

Abstract

The Lupus Foundation of America (LFA) convened an international working group to obtain a consensus definition of disease flare in lupus. With help from the Paediatric Rheumatology International Trials Organization (PRINTO), two web-based Delphi surveys of physicians were conducted. Subsequently, the LFA held a second consensus conference followed by a third Delphi survey to reach a community-wide agreement for flare definition. Sixty-nine of the 120 (57.5%) polled physicians responded to the first survey. Fifty-nine of the responses were available to draft 12 preliminary statements, which were circulated in the second survey. Eighty-seven of 118 (74%) physicians completed the second survey, with an agreement of 70% for 9/12 (75%) statements. During the second conference, three alternative flare definitions were consolidated and sent back to the international community. One hundred and sixteen of 146 (79.5%) responded, with agreement by 71/116 (61%) for the following definition: “A flare is a measurable increase in disease activity in one or more organ systems involving new or worse clinical signs and symptoms and/or laboratory measurements. It must be considered clinically significant by the assessor and usually there would be at least consideration of a change or an increase in treatment.” The LFA proposes this definition for lupus flare on the basis of its high face validity.

Publisher

SAGE Publications

Subject

Rheumatology

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