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Measuring Disease Activity and Damage with Validated Metrics: A Systematic Review on Mortality and Damage in Systemic Lupus Erythematosus

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Keeling SO1,2,3, Vandermeer B4,5,6, Medina J4,5,6, Chatterley T4,5,6, Nevskaya T4,5,6, Pope J4,5,6, Alaburubalnabi Z4,5,6, Bissonauth A4,5,6, Touma Z4,5,6. J Rheumatol. 2018 Oct;45(10):1448-1461. doi: 10.3899/jrheum.171310. Epub 2018 Aug 15.

Abstract

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1 From the Division of Rheumatology, Department of Medicine, and the Alberta Research Centre for Health Evidence, and the John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta; Division of Rheumatology, Department of Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. stephanie.keeling@ualberta.ca.

2 S.O. Keeling, MD, MSc, FRCP(C), Associate Professor, University of Alberta; B. Vandermeer, MSc, Biostatistician, Alberta Research Centre for Health Evidence, University of Alberta; stephanie.keeling@ualberta.ca.

3 T. Chatterley, MLIS, Librarian, John W. Scott Library, University of Alberta; T. Nevskaya, MD, PhD, Internal Medicine Resident, University of Western Ontario; J. Pope, MD, FRCP(C), Professor of Medicine, University of Western Ontario; Z. Alaburubalnabi, MBBS, ABIM, FRCPC, Assistant Professor, University of British Columbia; A. Bissonauth, MRes, Research Coordinator, University of Alberta; Z. Touma, MD, PhD, Assistant Professor, University of Toronto. Jorge Medina died February 4, 2018. stephanie.keeling@ualberta.ca.

4 From the Division of Rheumatology, Department of Medicine, and the Alberta Research Centre for Health Evidence, and the John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta; Division of Rheumatology, Department of Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

5 S.O. Keeling, MD, MSc, FRCP(C), Associate Professor, University of Alberta; B. Vandermeer, MSc, Biostatistician, Alberta Research Centre for Health Evidence, University of Alberta.

6 T. Chatterley, MLIS, Librarian, John W. Scott Library, University of Alberta; T. Nevskaya, MD, PhD, Internal Medicine Resident, University of Western Ontario; J. Pope, MD, FRCP(C), Professor of Medicine, University of Western Ontario; Z. Alaburubalnabi, MBBS, ABIM, FRCPC, Assistant Professor, University of British Columbia; A. Bissonauth, MRes, Research Coordinator, University of Alberta; Z. Touma, MD, PhD, Assistant Professor, University of Toronto. Jorge Medina died February 4, 2018.

Abstract

OBJECTIVE: To identify the effect of disease activity and damage, measured by validated indices, on mortality and damage accrual, in order to inform upcoming Canadian systemic lupus erythematosus (SLE) recommendations.

METHODS: Following GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to fill in evidence-to-decision tables to create recommendations for "minimal investigations needed to monitor SLE patients at baseline and subsequent visits," a systematic literature review was performed. The effect of disease activity and damage, measured by validated metrics, on mortality and damage was systematically reviewed, with metaanalyses performed when available.

RESULTS: A title/abstract screen of 5599 articles identified 816 articles for full paper review, with 102 meeting inclusion criteria and 53 with extractable data. Thirty-three articles describing outcomes related to disease activity and 20 articles related to damage were identified. Mortality was associated with higher SLE Disease Activity Index-2000 scores in 6 studies (HR 1.14, 95% CI 1.06-1.22) and higher Systemic Lupus International Collaborating Clinics/ACR Damage Index scores in 6 studies (HR 1.53, 95% CI 1.28-1.83). Higher SLE Activity Measure scores were associated with increased risk of damage in 3 studies (OR 1.06, 95% CI 1.04-1.08). British Isles Lupus Assessment Group was associated with mortality in 1 study with HR of 1.15.

CONCLUSION: Active SLE disease and damage are associated with and predict greater mortality and damage. The use of validated disease activity and damage metrics is important in the assessment of disease activity and damage and will inform upcoming Canadian recommendations for the assessment of SLE.