Responsiveness of clinical and ultrasound outcome measures in musculoskeletal systemic lupus erythematosus

Abstract

Objective To assess the responsiveness of clinical outcome measures in musculoskeletal SLE compared with US. Methods A prospective pilot study was conducted in consecutive SLE patients with inflammatory musculoskeletal symptoms. Clinical assessments including SLEDAI, BILAG, 28 tender and swollen joint counts, physician and patient visual analogue scales (VAS), and US were performed at 0, 2 and 4 weeks following 120 mg i.m. methylprednisolone acetate. Responsiveness was analysed using changes and effect sizes using Cohen’s criteria. Results Twenty patients were recruited. Fifteen out of 20 had clinical swelling at baseline. All clinical and US parameters were significantly improved at week 4 (all P ⩽ 0.01). Musculoskeletal-BILAG score improved in 16/20. Musculoskeletal-SLEDAI improved in 7/20. SLE responder index 4 criteria were assessed in 19 patients with SLEDAI ⩾4 at baseline and were met in 9/19 at 4 weeks. Effect sizes at 4 weeks were large (>0.5) for US, physician VAS and BILAG, and medium (>0.3) for joint counts and SLEDAI. Large effect sizes for improvement in US grey-scale and power Doppler were observed in both SLE responder index 4 responders (r = −0.51 and −0.56, respectively) and non-responders (r = −0.62 and −0.59, respectively) at 4 weeks. Conclusion This is the first study to measure the responsiveness of clinical outcome measures in musculoskeletal SLE against an objective inflammation measure. BILAG and physician VAS were the most responsive clinical instruments. US was highly responsive in musculoskeletal SLE, while SLEDAI and joint counts appeared suboptimal for detection of improvement. These results suggest that clinical trials based on the SLEDAI and SLE responder index 4 may underestimate the efficacy of therapy in SLE.

Response to: ‘Assessment of responsiveness of the musculoskeletal component of SLE-DAS in an independent cohort’, by Hassan et al

“…Hassan et al report in their letter that in an analysis of 20 SLE patients, the responsiveness of the arthritis component of SLE-DAS (large effect size of −0.548) is superior to that of the arthritis component of SLE Disease Activity Index (DAI)-2K (medium effect size of −0.418) 1 3. These results corroborate our data 2 4.…”

Assessment of responsiveness of the musculoskeletal component of SLE-DAS in an independent cohort

“…Our group is researching outcome measures in musculoskeletal SLE. We published a previous study of responsiveness of various musculoskeletal outcome measures in patients treated with glucocorticoids 2. As expected, the musculoskeletal component of the SLEDAI-2K was less responsive than the physician visual analog scale (physician VAS), musculoskeletal component of the British Isles Lupus Assessment Group (BILAG) index or ultrasound, all of which allow for various grades of severity.…”

Ultrasound to identify systemic lupus erythematosus patients with musculoskeletal symptoms who respond best to therapy: the US Evaluation For mUsculoskeletal Lupus longitudinal multicentre study

“…There were limited existing data on the most appropriate clinical measure of improvement [ 14 ]. We therefore conducted an internal pilot analysis of the first 70 patients (clinical data only).…”