Moreover, a difference between the interRR of the PGA assessed by an untrained physician (0.50.63) and a trained investigator (0.790.81) was found, suggesting the need for PGA scoring training or standardization [36]. , Sayedbonakdar Z , Chan KL , Koutsoviti S T1 - Associations between physicians' global assessment of disease activity and patient-reported outcomes in patients with systemic lupus erythematosus. MD globals may vary based on their age, gender, practice setting and experience (number of patients seen per year and years in practice). Identification of new candidate drugs for primary Sjgrens syndrome using a drug repurposing transcriptomic approach, When it looks like Behets syndrome but is something else: Differential diagnosis of Behcets syndrome: a two-centre retrospective analysis, Huge water-balloons in the belly: multiple pancreatic pseudocysts in systemic lupus erythematosus, A randomized, double-blind, placebo-controlled, parallel group study on the effects of a cathepsin S inhibitor in primary Sjgrens syndrome, How to plug the leaky pipeline in clinical rheumatology across Europelessons to be learned from experiences in business, About the British Society for Rheumatology, British Society for Rheumatology Journals, https://doi.org/10.1093/rheumatology/keaa383, https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model, Receive exclusive offers and updates from Oxford Academic, Copyright 2023 British Society for Rheumatology. The last EULAR/ACR recommendations recommended use of the PGA in the routine monitoring of SLE [16]. et al. , Kalunian K Patient global assessment (PGA) is one of the most widely used PROs in RA practice and research and is included in several composite scores such as the 28-joint Disease Activity Score (DAS28). , Lin M , Beresford MW inflammation (duration and severity of morning stiffness as measured by BASDAI). Construct validity was recognized in 21 studies [2, 10, 11, 23, 24, 2629, 35, 47, 52, 54, 65, 68, 76, 84, 88, 92, 99, 101]. Brunner HI , Kostopoulou M disease activity). Fanouriakis A , Leung HW Currently the lack of standardized scoring, as well as the subjectivity of the physician judgements, can be an important source of heterogeneity, especially in trials. Strength. No study has evaluated the feasibility of the PGA in SLE to date. A Comprehensive Digest of Research Publications From Cedars-Sinai Investigators. Of note, it is not trivial that we found a good convergent validity with other instruments (SLEDAI, BILAG, LAI, SLAM and ECLAM) [10, 23, 24, 26, 28, 29, 35, 54, 68, 76, 84, 99]. Criterion validity data reporting correlation coefficients between PGA and quality of life measures, laboratory markers and miscellaneous. , Matos A , Bonithon-Kopp C Quimby KR Patient-reported outcomes (PROs) reflect the patient's perspective and are used in rheumatoid arthritis (RA) routine clinical practice. 1), accounting for 49 longitudinal cohort studies, 25 cross-sectional studies, 7 randomized controlled trials, 3 consensus conferences, 4 post-hoc analyses, 2 retrospective studies and 1 case series. PGA is often assessed by a single question with a 0-10 or 0 . The sensitivity to change was estimated to be the smallest for the SLEDAI; the standardized response means were 0.48 when the physician global assessment was used as the standard and 0.01 when the patient global assessment was used . The Physician Global Assessment (PGA) of treatment response measures the overall response to treatment as assessed by the physician. Beaton DE sharing sensitive information, make sure youre on a federal , Sengupta M , Floris A physician global assessment Recently Published Documents. Uribe AG, Vil LM, McGwin G Jr, Sanchez ML, Reveille JD, Alarcn GS. [8] suggested that the PGA should account for objective examination, laboratory results and what patients report. , Socher SA HHS Vulnerability Disclosure, Help Background: Physician Global Assessment (PGA) is a visual analogue score (VAS) that reflects the clinician's judgment of overall Systemic Lupus Erythematosus (SLE) disease activity. Of note, the literature search revealed heterogeneous definitions of physician assessment of disease activity other than the PGA (physician global assessment [4, 70, 73], physician overall assessment [85]). allergy hx phenothiazines, cns depressants and stimulants withheld 48 hours prior. , Morabito LM , Sadovici-Bobeica V RN-BSN HOLISTIC HEALTH ASSESSMENT ACROSS THE LIFESPAN (NURS 3315) Sociology of Social Problems (SOC213) The index assesses separately eight organ-based systems. This may be explored through convergent and divergent validity. Schneider M , Perez-Gutthann S , Block JA Rendas-Baum R, Baranwal N, Joshi AV, Park J, Kosinski M. J Patient Rep Outcomes. Learn more. , Petri M While specific studies remain to be performed to determine the optimal method for scoring the PGA, this literature search showed that the most adopted form of PGA was a 10cm 03 VAS with anchors (0, none; 1, mild; 2, moderate; 3, severe activity) [3]. , Subach RB The assessment of disease activity in SLE is particularly challenging. 2022 Mar 14;24(1):70. doi: 10.1186/s13075-022-02756-3. Criterion validity. Observed and articulated management issues and responses. These results enabled its use as a gold standard for assessing flare and defining flare severity in several studies [21, 67, 88]. , Hochberg M. Wallace DJ et al. , Gallacher AE et al. , Urowitz MB. PGA; disease activity; physician global assessment; psychometrics; systemic lupus erythematosus. . Supervise the development of junior medical affairs staff . , Kiani AN et al. PGA responsiveness was used to assess flare [9]: PGA was identified as the gold standard to rate the exacerbation of lupus activity [21, 67, 88], preliminarily defined by a change of 1.0 on a 03 VAS since the last visit. The last MEDLINE search was performed on 1 July 2019. However, the PGA allows for the measurement of disease activity in a global way (content validity). The following search strategy was used through MEDLINE via PubMed: (((lupus erythematosus, systemic[MeSH Terms] OR (lupus[TIAB] AND erythematosus[TIAB] AND systemic[TIAB]) OR systemic lupus erythematosus[TIAB] OR (systemic[TIAB] AND lupus[TIAB] AND erythematosus[TIAB]))) OR SLE[TIAB]) AND (physician global assessment[TIAB] OR PGA[TIAB]). The Physician Global Assessment International Standardisation COnsensus in Systemic Lupus Erythematosus (PISCOS) study aimed to obtain an evidence-based and expert-based consensus standardisation of the Physician Global Assessment (PGA) scoring of disease activity in systemic lupus erythematosus (SLE). [35], the PGA correlated, although moderately, with the need for treatment change (r=0.46, P<0.01). [8] suggested the need for a disease activity instrument that would be valid, reliable and sensitive to change. , Matos A The interRR was assessed in seven studies [4, 10, 11, 36, 65, 68, 94], showing values ranging from 0.67 [68] to 0.96 [94]. However, it is important to remember that not all clinical problems reported by a lupus patient are due to the disease. , Pego-Reigosa J-M On stratifying the results by individual clinician, values ranged from 0.61 to 0.90, except for those reported by . Criterion validity is defined as the degree to which the scores of an instrument adequately reflect the truth in the form of a gold standard [107]. Barr SG Content validity was reported in 89 studies. Physician global assessments for disease activity in rheumatoid arthritis are all over the map! , Longenecker JC The judgment of whether a patient with SLE has active disease is a central question both in routine patient management and in clinical research [4]. . , Schur PH. , Petri MA Changes in the PGA correlated with changes of other disease activity indices (SLEDAI, SLAM, LAI, patient global assessment), laboratory exams (ESR), patient-reported outcomes (Lupus Impact Tracker) [23, 50, 58, 77, 78, 81, 83] and response to treatment [4]. SELENA SLEDAI4. Assessing disease activity in rheumatic diseases such as systemic lupus erythematosus (SLE) is vital for effective treatment. Methods Patients attending a rheumatology clinic between 2013 and 2017 completed specific (SLEQOL) and generic (SF36) health-related quality of life (HRQoL) surveys and rated . In our centre, new tools for the assessment of SLE activity: the Lupus Activity Scoring Tool (LAST) and Clinical Lupus Activity Scoring Tool (C-LAST) were developed and validated. This potentially disfiguring disease can have significant impact on patient's quality of life (QoL) and is often refractory to many first- and second-line therapies. , Petri M. Foering K , Brunetta P J Clin Med. The PGA also showed good predictive validity, as it correlated significantly with measures of future outcomes, such as quality of life or laboratory exams, but no study has currently evaluated its correlation with measures of damage. Results: The Physician Global Assessment (PGA) is a visual analogue score that reflects the clinicians judgement of overall SLE disease activity. Vil LM official website and that any information you provide is encrypted . , OMalley T physician's global assessment (PGA) of disease activity in SLE. et al. Fatigue is independently associated with disease activity assessed using the Physician Global Assessment but not the SLEDAI in patients with systemic lupus erythematosus. Different definitions of PGA retrieved through the literature search are reported in Table1. In the second column, the definitions were reported according to the VAS used in the study. FOIA Myelogram - correct answer NPO for 4-6 hours. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. , Giangreco D Data regarding divergent validity are lacking for the PGA. An assessment of disease flare in patients with systemic lupus erythematosus: a comparison of BILAG 2004 and the flare version of SELENA. Because of its dynamic nature, this disease has an unpredictable natural course leading to high . The PGA is a valid instrument but has variable reliability; its scoring should be standardized. This is a top barrier, both for treat-to-target management of SLE patients in clinical practice, as well as in clinical trials for new SLE treatments. Navarra SV , Petri M. Iaccarino L Search for other works by this author on: Rheumatology Unit, AOU University Clinic and University of Cagliari, Department of Medical Sciences and Public Health, Cagliari, Italy, Centre Hospitalier Universitaire de Dijon, Hpital Franois-Mitterrand, service de mdecine interne et maladies systmiques (mdecine interne, 2) et Centre dInvestigation Clinique, Service de rhumatologie, Hpitaux Universitaires de Strasbourg, Universit de Strasbourg, Centre National de Rfrence des Maladies Systmiques et Autoimmunes Rares Est Sud-Ouest (RESO). Measurement properties of the PGA were analysed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) terminology [19]. COSMIN Terminology from a European Rheumatology Perspective: a Glossary for the EULAR PRO Tool Box Initiative. A total of 91 articles were included in the study (Fig. Oxford University Press is a department of the University of Oxford. Criterion validity also refers to the degree to which an instrument predicts aspects and phenomena occurring in the future [108]. Liang et al. AU - Louthrenoo, Worawit. , James JA et al. All rights reserved. , Petri M. Isenberg DA , Mikolaitis-Preuss RA 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). 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. , Emamikia S Forbess LJ , Hochberg M. Touma Z In two studies, the PGA-VAS was used to assess concepts other than disease activity: disease severity [4] and patients compliance with treatments [103]. According to the OMERACT, face validity is the degree to which the instrument appears to match with the target domain, according to experts [18]. Franklyn K , Adamichou C The patients were diagnosed as having the following disorders: scleroderma (n = 27), dermatomyositis (n = 11), systemic lupus erythematosus (SLE) (n = 22), MCTD (n = 8), and RP without evidence of underlying CTD (n = 38). 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). Construct validity was demonstrated by a good correlation (r0.50) between the PGA with the SLEDAI (12 studies), SLAM (4 studies), LAI, BILAG and ECLAM (2 studies each). In one open-label study [43], the decrease in PGA score was considered the primary endpoint. Different scores and lengths of visual evaluation were employed: the first was the 010 VAS suggested by Liang et al. , Piette EW However, it was used as a single outcome measure only in two studies [49, 100], while in the majority the PGA was scored together with another instrument (typically the SLEDAI) [2, 9, 11, 12, 21, 24, 30, 32, 34, 3740, 44, 45, 48, 49, 55, 58, 59, 61, 63, 64, 66, 67, 74, 75, 80, 82, 86, 8995, 103]. , Larson MG All rights reserved. . To increase its reliability, the PGA should be scored by a physician with significant expertise in SLE, with prior knowledge of laboratory results [112], considering the overall disease activity at the time of the visit and comparing it to the last visit in order to assess flares [9]. 2) [10, 23, 24, 26, 28, 29, 35, 54, 68, 76, 84, 99], with the SLAM in 4 studies (r=0.470.65) [35, 76, 84, 99], with LAI in 2 studies (r=0.640.75) [68, 84], with BILAG in 2 studies (r=0.610.62) [35, 84] and with ECLAM in 2 studies (r=0.580.65) [35, 84]. et al. Additional papers were obtained by checking the references from the selected studies. Touma Z , Cappellazzo G PGA is a valid, responsive and feasible instrument, while its reliability was impacted by the scale adopted, suggesting the major need for a standardization of its scoring. , Alarcn GS Reviews and case series with fewer than five patients were excluded. Physician global assessments for disease activity in rheumatoid arthritis are all over the map!. Feasibility refers not to the quality of the outcome measure, but to aspects such as completion time, cost of an instrument, equipment and type and ease of administration. Copay AG Ruiz-Irastorza G Content validity was reported in 89 studies. The LUMINA (Lupus in Minorities: Nature versus Nurture) study and other trials have offered evidence of a decrease in flares and prolonged life in patients given hydroxychloroquine, making . Clinical composite measures of disease activity and damage used to evaluate patients with systemic lupus erythematosus: A systematic literature review. A PGA >1 was predictive of polymorphic light cutaneous eruption (P=0.02) [59] and correlated negatively with LLDAS attainment [37]. The pooled correlation coefficient (95% CI) is given both for the fixed effects model and the random effects model. Notorious to increase IOP and cause severe PAIN and headache; Diagnostics: - History - Tonometry examinations - measures IOP QUESTION A client states that the physician has told her that her intraocular was 14. The PGA intraRR was assessed in three studies [10, 68, 94] and ranged from 0.55 [68] to 0.88 [10]. , Hennis A. Jesus D An official website of the United States government. Epub 2014 Apr 11. It is unclear when or with what justification the physician global assessment of disease status (PhGA) was first used to assess patients with systemic . , Costenbader K , McGwin G , Mazur M. Fatemi A , Petri M. Thanou A Enocsson H This suggests that the role of the PGA is limited for disease activity assessment when used as a single instrument. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). , Wallace DJ It can affect the joints, skin, brain, lungs, kidneys, and blood vessels. The aim of this systematic literature review (SLR) is to describe and analyse the psychometric properties of PGA. The PGA was integrated in composite indices, including the definition of the LLDAS [12, 13, 29, 34, 37, 39, 40] and remission [29, 37] (Table1). The Physician Global Assessment (PGA) is a visual analogue score that reflects the clinician's judgement of overall SLE disease activity. Medical-Surgical Nursing Clinical Lab (NUR1211L) U.S. History Themes (HIS-144) Nursing Process IV: Medical-Surgical Nursing (NUR 411) Maternity Nursing Care; Professional Roles and Values (C 304) Survey of United States History (C121) Trending. A good correlation was considered for a value >0.60. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of multifactorial origin that can affect any organ or organ system, resulting in a broad spectrum of clinical manifestations ranging from dermatological involvement to multi-organ failure with episodes of relapses and remissions. Subsequently the PGA was incorporated in the Safety of Estrogen in Lupus Erythematosus National Assessment (SELENA) flare index (SFI) in 1999 [10], in the Systemic Responder Index (SRI) in 2009 [3, 11, 12] as well as in the definitions of the Lupus Low Disease Activity State (LLDAS) [13] and various definitions of remission [14, 15]. , Suriano A A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [17], searching for articles reporting on the use of PGA in SLE.
