Use of Physician Global Assessment in systemic lupus erythematosus: a systematic review of its psychometric properties

Abstract

Objective The Physician Global Assessment (PGA) is a visual analogue score that reflects the clinician’s judgement of overall SLE disease activity. The aim of this systematic literature review is to describe and analyse the psychometric properties of the PGA. Methods This systematic literature review was conducted by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All articles published through 1 July 2019 in PubMed were screened, with no limitation on year of publication, language or patients’ age. Psychometric properties data were analysed according to the OMERACT Filter methodology version 2.1. Results The literature search identified 91 studies. Face validity was reported in all the articles retrieved in which the PGA was used alone or as part of composite indices (Systemic Responder Index, Safety of Estrogen in Lupus Erythematosus National Assessment Flare Index, Lupus Low Disease Activity State, Definitions of Remission in Systemic Lupus Erythematosus criteria). Content validity was reported in 89 studies. 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). 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. A good responsiveness for PGA was shown in eight studies. A high variability in scales was found, causing a wide range of reliability (intraclass correlation coefficient 0.67–0.98). Conclusion 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.

Lack of Association between Serum Interleukin-23 and Interleukin-27 Levels and Disease Activity in Patients with Active Systemic Lupus Erythematosus

“…This is a retrospective, cross-sectional study. Clinical information was assessed with the application of a questionnaire that included: Demographic data (age, sex); Medical history/clinical data; Current treatment; Laboratory results (titer and profile of ANAs [ 31 ], anti-dsDNA [ 34 ], complement components C3 and C4 concentrations, and serum IL-23 and IL-27 concentrations); Measurements (morphology, biochemistry, urinalysis, daily proteinuria); Disease activity measured with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2-K) [ 35 , 36 ], Physician Global Assessment (PGA) [ 37 ], and organ damage determined using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) [ 38 ]. …”

“…Disease activity measured with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2-K) [ 35 , 36 ], Physician Global Assessment (PGA) [ 37 ], and organ damage determined using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) [ 38 ].…”

“…The PGA is a visual analogue score, recommended in the recent European League Against Rheumatism (EULAR) guidelines [ 39 ], for evaluating disease activity, treatment response, and remission in SLE [ 37 ].…”

A Review of Systemic Lupus Erythematosus (SLE): Symptoms, Risk Factors, Treatment, and Health Related Quality of Life Issues

“…These notations are the default naming of groups provided by the software program R. Open Journal of Rheumatology and Autoimmune Diseases Several important components of the HRQOL instruments need explanation in the above figures; they are "The Physician Global Assessment" (PGA). The PGA [120] is a visual analogue score that reflects the clinician's judgment of overall SLE disease activity.…”

Patient Experiences, Satisfaction, and Expectations with Current Systemic Lupus Erythematosus Treatment: Results of the SLE-UPDATE Survey

“…In addition to the treatment goals described, more recent initiatives have set out to establish standardized treat-to-target goals in SLE including remission and low disease activity states [ 6 ]. Remission and low disease activity are defined based on validated clinician-assessed instruments, such as the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) [ 7 ] and the Physician’s Global Assessment (PGA) [ 8 ]. Maximum thresholds of glucocorticoid dose are also incorporated in these definitions.…”