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, Johanna Mucke Department for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University , Düsseldorf, Germany Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University , Düsseldorf, Germany Correspondence to: Johanna Mucke, Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany. E-mail: Johanna.Mucke@med.uni-duesseldorf.de Search for other works by this author on: Oxford Academic Christina Düsing Department for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University , Düsseldorf, Germany Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University , Düsseldorf, Germany Search for other works by this author on: Oxford Academic Tim Filla Department for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University , Düsseldorf, Germany Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University , Düsseldorf, Germany Search for other works by this author on: Oxford Academic Gamal Chehab Department for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University , Düsseldorf, Germany Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University , Düsseldorf, Germany Search for other works by this author on: Oxford Academic Matthias Schneider Department for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University , Düsseldorf, Germany Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University , Düsseldorf, Germany Search for other works by this author on: Oxford Academic
https://orcid.org/0000-0001-8915-7837 Rheumatology, Volume 63, Issue 6, June 2024, Pages 1649–1655, https://doi.org/10.1093/rheumatology/kead460
Published:
07 September 2023
Article history
Received:
21 June 2023
Accepted:
16 August 2023
Published:
07 September 2023
Corrected and typeset:
15 September 2023
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Johanna Mucke, Christina Düsing, Tim Filla, Gamal Chehab, Matthias Schneider, Defining the physician global assessment threshold equivalent to remission in patients with systemic lupus erythematosus, Rheumatology, Volume 63, Issue 6, June 2024, Pages 1649–1655, https://doi.org/10.1093/rheumatology/kead460
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Abstract
Objectives
The optimal threshold of the physician global assessment (PGA) for remission in SLE has never been evaluated systematically. The aim of this study was to assess the ideal PGA threshold associated with physician remission and to investigate its impact on remission rates in our lupus cohort.
Methods
In this monocentric cross-sectional study, patients with SLE were evaluated for physician remission by asking the treating physicians whether they considered their patient to be in remission, regardless of objective remission criteria. Furthermore, two objective remission definitions were applied: (i) DORIS (Definition Of Remission In Systemic Lupus Erythematosus) remission using a PGA of <2 (0–10) (corresponding to <0.5 on a visual analogue scale 0–3 used in DORIS); and (ii) DORIS remission with omission of PGA (modDORIS). A receiver operating characteristic analysis and regression analyses were performed to assess the ideal PGA threshold and factors influencing PGA.
Results
Of the 233 patients included, 126 patients (54.0%) were in physician remission, 42.5% in DORIS remission and 67.0% in modDORIS remission. A PGA of <2 [numeric rating scale (NRS) 0–10] had the highest sensitivity (79%) and specificity (81%) for physician remission and modDORIS (area under the curve 0.85 and 0.69). PGA of patients fulfilling any of the remission definitions was associated with pain and hypocomplementemia. Damage was numerically higher in patients in modDORIS only; no association between PGA and damage was found in regression analysis.
Conclusion
Using a PGA threshold of <2 (0–10), corresponding to <0.6 (0–3), resulted in best prediction of physician remission. PGA levels seem to be influenced by pain and complement levels but not disease damage.
SLE, physician global assessment, remission
© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)
Topic:
- systemic lupus erythematosus
- disease remission
Issue Section:
Clinical Science
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