{
  "abstract": "Objectives To identify predictive correlates of discordance between the Physician’s Global Assessment Score (PGA) and remaining Lupus Low Disease Activity State (LLDAS) criteria, among patients who attain low disease activity at individual visits.Methods Patient visit data from the Asia-Pacific Lupus Collaboration (APLC) Cohort (2013-2020) were collected, with prior ethical approval. We included all visits where patients attained LLDAS criteria, minus the PGA criterion. PGA (0-3) concordance was defined as PGA<1, discordance defined as PGA>1, per LLDAS criteria. Data including demographics, clinical disease activity (SLE Disease Activity Index (SLEDAI-2K)), serologic disease activity (C3, C4, anti-DNA antibodies), inflammatory markers (C-reactive protein and Erythrocyte Sedimentation Rate) and treatments were collected. Statistical analysis was performed using descriptive statistics and mixed-effects logistic regression models.Results We included 19632 visits of 2973 patients (92% female, 88% Asian, median follow-up 2.5 years). Four hundred and fifty-six visits (2.9%) were not in LLDAS due to PGA discordance; the remainder met all LLDAS criteria. During most visits (n=18328, 93%), patients had only serologic or no disease activity and PGA discordance was 1.5-3.9%. Visits with arthritis (n=156) had the highest frequency of PGA discordance (14.7%). Demographic factors negatively associated with PGA discordance included age, tertiary education, high-income country residence. Rash, alopecia, arthritis, thrombocytopenia, leukopenia, and serologic activity were independent predictors of PGA discordance. Across visits with only serologic activity, higher SLEDAI-2K score at previous visit, raised anti-DNA antibodies, and addition of prednisolone were predictive of PGA discordance. Across visits with no disease activity, higher SLEDAI-2K score at previous visit, prednisolone dose intensification and addition of azathioprine were predictive of PGA discordance; hydroxychloroquine use was negatively associated with discordance.Conclusions PGA discordance with other LLDAS criteria was infrequent in the APLC cohort (2.9%), due to most eligible visits having no documented clinical disease activity. However, among visits with clinical disease activity, PGA was discordant in up to 15% of cases. PGA discordance in visits with serologic only or no disease activity was predicted by higher SLEDAI-2K score at previous visit or treatment intensification. PGA may therefore operate as an indicator of disease severity or disease activity not captured by SLEDAI-2K, within the LLDAS definition.",
  "authors": [
    {
      "affiliations": [
        "University of Melbourne at St Vincent’s Hospital, Fitzory, Australia",
        "Department of Rheumatology, St Vincent’s Hospital Melbourne, Fitzroy, Australia"
      ],
      "name": "Luigi Zolio"
    },
    {
      "affiliations": [
        "Department of Rheumatology, St Vincent’s Hospital Melbourne, Fitzroy, Australia"
      ],
      "name": "Dylan Hansen"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Australia"
      ],
      "name": "Rangi Kandane-Rathnayake"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand"
      ],
      "name": "Worawit Louthrenoo"
    },
    {
      "affiliations": [
        "Rheumatology Division, Department of Medicine, National University Hospital, Singapore, Singapore"
      ],
      "name": "Jiacai Cho"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Division of Medicine, Woodlands Health, Singapore, Singapore"
      ],
      "name": "Aisha Lateef"
    },
    {
      "affiliations": [
        "Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung"
      ],
      "name": "Yi-Hsing Chen"
    },
    {
      "affiliations": [
        "Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong Sar, China"
      ],
      "name": "Cs Lau"
    },
    {
      "affiliations": [
        "Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong Sar, China"
      ],
      "name": "Shirley Chan"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia"
      ],
      "name": "Laniyati Hamijoyo"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taipei"
      ],
      "name": "Shue Fen Luo"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taipei"
      ],
      "name": "Yeong-Jian Wu"
    },
    {
      "affiliations": [
        "Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines"
      ],
      "name": "Sandra Navarra"
    },
    {
      "affiliations": [
        "Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines"
      ],
      "name": "Leonid Zamora"
    },
    {
      "affiliations": [
        "Department of Medicine, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia"
      ],
      "name": "Sargunan Sockalingam"
    },
    {
      "affiliations": [
        "Department of Rheumatology and Immunology, Peoples Hospital, Peking University Health Science Center, Beijing, China"
      ],
      "name": "Zhanguo Li"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Tokyo Women’s Medical University, Tokyo, Japan"
      ],
      "name": "Yasuhiro Katsumata"
    },
    {
      "affiliations": [
        "Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China"
      ],
      "name": "Zhuoli Zhang"
    },
    {
      "affiliations": [
        "Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China"
      ],
      "name": "Yanjie Hao"
    },
    {
      "affiliations": [
        "Department of Nephrology, Teaching Hospital Kandy, Kandy, Sri Lanka"
      ],
      "name": "Bmdb Basnayake"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore"
      ],
      "name": "Madelynn Chan"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan"
      ],
      "name": "Jun Kikuchi"
    },
    {
      "affiliations": [
        "Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan"
      ],
      "name": "Tsutomu Takeuchi"
    },
    {
      "affiliations": [
        "Department of Rheumatology, North Shore Hospital, Health New Zealand Waitemata, Auckland, New Zealand"
      ],
      "name": "Kristine (Pek Ling) Ng"
    },
    {
      "affiliations": [
        "Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology Research, Seoul, South Korea"
      ],
      "name": "Sang-Cheol Bae"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Flinders Medical Centre, Bedford Park, SA, Australia"
      ],
      "name": "Fiona Goldblatt"
    },
    {
      "affiliations": [
        "Rheumatology Department, Liverpool Hospital, Liverpool, NSW, Australia"
      ],
      "name": "Geraldine Hassett"
    },
    {
      "affiliations": [
        "Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore"
      ],
      "name": "Tze Chin Tan"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Greenlane Clinical Centre, Health New Zealand Auckland, Te Whatu Ora, Auckland, New Zealand"
      ],
      "name": "Nicola Tugnet"
    },
    {
      "affiliations": [
        "Department of Rheumatology, Middlemore Hospital, Health New Zealand Counties Manukau, Te Whatu Ora, Auckland, New Zealand"
      ],
      "name": "Mark Sapford"
    },
    {
      "affiliations": [
        "College of Medicine, University of the Philippines, Manila, Philippines"
      ],
      "name": "Cherica Tee"
    },
    {
      "affiliations": [
        "College of Medicine, University of the Philippines, Manila, Philippines"
      ],
      "name": "Michael Tee"
    },
    {
      "affiliations": [
        "The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan"
      ],
      "name": "Yoshiya Tanaka"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Australia",
        "Novartis Pharma, Basel, Switzerland"
      ],
      "name": "Vera Golder"
    },
    {
      "affiliations": [
        "Feinstein Institutes for Medical Research, Manhasset, New York, USA"
      ],
      "name": "Cynthia Aranow"
    },
    {
      "affiliations": [
        "Columbia University, New York, New York, USA"
      ],
      "name": "Anca Askanase"
    },
    {
      "affiliations": [
        "Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Clayton, Australia",
        "Novartis Pharma, Basel, Switzerland"
      ],
      "name": "Alberta Hoi"
    },
    {
      "affiliations": [
        "University of Melbourne at St Vincent’s Hospital, Fitzory, Australia",
        "Novartis Pharma, Basel, Switzerland"
      ],
      "name": "Eric Morand"
    },
    {
      "affiliations": [
        "Department of Rheumatology, North Shore Hospital, Health New Zealand Waitemata, Auckland, New Zealand",
        "University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Sean O’neill"
    },
    {
      "affiliations": [
        "University of Melbourne at St Vincent’s Hospital, Fitzory, Australia"
      ],
      "name": "Shereen Oon"
    },
    {
      "affiliations": [
        "University of Melbourne at St Vincent’s Hospital, Fitzory, Australia",
        "Department of Rheumatology, St Vincent’s Hospital Melbourne, Fitzroy, Australia",
        "University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Mandana Nikpour"
    }
  ],
  "title": "PO:07:177 Predictors of the physician’s global assessment (PGA) score among SLE patients in low disease activity",
  "uid": "1b964f5e-711c-56dc-a85a-d87b84a787e1"
}