A new paper in Rheumatology, published by Oxford University Press, indicates that researchers have developed a new, easier, and more accurate tool to measure the progress of lupus in patients.
Systemic lupus erythematosus affects up to 1.5 million people in the United States and about one in 1000 people in the United Kingdom. The autoimmune disease causes the body’s immune system to attack its own healthy tissues, especially the joints, skin, and kidneys. Doctors need to measure the progress of the disease to make accurate decisions about treatment. Numerous studies have shown that keeping disease activity well controlled leads to less long-term organ damage. However, in a disease with so many different features this can be difficult to assess.
The standard tool used to measure disease progression, called the BILAG-2004 index, uses multiple reference documents including a case report form, a detailed glossary, and separate scoring algorithms covering nine different areas. This is often too difficult or time-consuming for doctors to complete during routine clinic visits, particularly for those less familiar with the format. The challenges of the standard index can make it difficult for physicians to measure disease accurately and consistently. In clinical trials, the training required is long, mistakes in scoring are common, and physicians often express frustration with the method.
Researchers developed a new “Easy-BILAG” project to help doctors assess lupus using a simpler, faster tool. Easy-BILA, is a single-page document using color-coding to make assessment more user friendly way. The researchers found that, when compared across a variety of factors, the new tool enabled more accurate, consistent, and time efficient measurements of lupus disease progression. Overall accuracy was boosted to 96% and general hospital rheumatologists could measure disease progression accurately in 91.3% of cases using the new tool, compared with only 75% when using the more difficult standard format. Rheumatologists were able to use the new tool to assess cases faster, in under an hour. The standard format took an average 80 minutes to complete.
Rheumatologists rated the new tool as intuitive and well adapted for routine clinical practice and expressed willingness to use it routinely. “The standard-format BILAG is useful for assessing individual patients,” said the paper’s author, Edward Vital, “but its downside was always the time and training needed to complete it. Being able to measure the progress of lupus quickly and easily has transformed my practice so I’m excited that we can now make it easy for anyone to do the same.”
The paper, “Easy-BILAG: a new tool for simplified recording of SLE disease activity using BILAG-2004 index,” is available (at midnight on January 25th) at: https://academic.oup.com/rheumatology/article-lookup/doi/10.1093/rheumatology/keab883.
Direct correspondence to:
Leeds Institute for Rheumatic and Musculoskeletal Medicine
Chapel Allerton Hospital
Leeds LS7 4SA, UNITED KINGDOM