International consensus for a definition of disease flare in lupus

  • Ruperto, N
  • Hanrahan, LM
  • Alarcón, GS
  • Belmont, HM
  • Brey, RL
  • Brunetta, P
  • Buyon, JP
  • Costner, MI
  • Cronin, ME
  • Dooley, MA
  • Filocamo, G
  • Fiorentino, D
  • Fortin, PR
  • Franks, AG Jr
  • Gilkeson, G
  • Ginzler, E
  • Gordon, C
  • Grossman, J
  • Hahn, B
  • Isenberg, DA
  • Kalunian, KC
  • Petri, M
  • Sammaritano, L
  • Sánchez-Guerrero, J
  • Sontheimer, RD
  • Strand, V
  • Urowitz, M
  • von Feldt, JM
  • Werth, VP
  • Merrill, JT
Lupus 20(5):p 453-462, April 2011. | DOI: 10.1177/0961203310388445

The Lupus Foundation of America (LFA) convened an international working group to obtain a consensus definition of disease flare in lupus. With help from the Paediatric Rheumatology International Trials Organization (PRINTO), two web-based Delphi surveys of physicians were conducted. Subsequently, the LFA held a second consensus conference followed by a third Delphi survey to reach a community-wide agreement for flare definition. Sixty-nine of the 120 (57.5%) polled physicians responded to the first survey. Fifty-nine of the responses were available to draft 12 preliminary statements, which were circulated in the second survey. Eighty-seven of 118 (74%) physicians completed the second survey, with an agreement of 70% for 9/12 (75%) statements. During the second conference, three alternative flare definitions were consolidated and sent back to the international community. One hundred and sixteen of 146 (79.5%) responded, with agreement by 71/116 (61%) for the following definition: “A flare is a measurable increase in disease activity in one or more organ systems involving new or worse clinical signs and symptoms and/or laboratory measurements. It must be considered clinically significant by the assessor and usually there would be at least consideration of a change or an increase in treatment.” The LFA proposes this definition for lupus flare on the basis of its high face validity.

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