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
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.