The PGA is a well accepted and commonly used scale for evaluating treatment response in clinical trials both in adults and children. These results enabled its use as a gold standard for assessing flare and defining flare severity in several studies [21, 67, 88]. Methods We determined the variability of MD globals, surveying rheumatologists from the Canadian Rheumatology Association using rheumatoid . The assessment of disease activity in SLE is particularly challenging. The SRI is a composite instrument comprised of the SELENA-SLE Disease Activity Index [SELENA-SLEDAI], Physician Global Assessment (PGA) and British Isles Lupus Assessment Group (BILAG) 2004. 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]. , Saad-Magalhes C , Floris A allergy hx phenothiazines, cns depressants and stimulants withheld 48 hours prior. The literature search identified 91 studies. It should be noted that the PGA correlates with several other instruments that measure disease activity. , Brunetta P The content can vary and relates either to global health (e . , Sato JO et al. AU - Kandane-Rathnayake, Rangi. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. The aim of this systematic literature review (SLR) is to describe and analyse the psychometric properties of PGA. Neuropsychiatry OXFORD TEXTBOOKS IN PSYCHIATRY Oxford Textbook of Neuropsychiatry Edited by Niruj Agrawal, Rafey Faruqui, and Mayur Bodani Oxford Textbook of Psychiatry of Intellectual Disability Edited by Sabyasachi Bhaumik and Regi Alexander Oxford Textbook of Inpatient Psychiatry Edited by Alvaro Barrera, Caroline Attard, and Rob Chaplin Oxford Textbook of Attention . This suggests that the role of the PGA is limited for disease activity assessment when used as a single instrument. Navarra SV The aim of this systematic review is to describe and analyse the measurement properties of the PGA, including the validity, reliability, responsiveness and feasibility. Physician global assessments for disease activity in rheumatoid arthritis are all over the map!. , Stavrakis S It does not provide a predefined or limited list of disease manifestations or organ systems, thus allowing one to capture all the heterogeneous aspects of SLE disease activity. Glossary: PGA. Arriens C Published by Oxford University Press on behalf of the British Society for Rheumatology. Thanks to this feature, the PGA was included in composite indices with the aim of rating manifestations not included in glossary-based instruments such as the SLEDAI and BILAG [3] or for which a threshold has been defined (cytopenia). Reviews and case series with fewer than five patients were excluded. 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]. Few studies reported on whether serological activity should be incorporated in the PGA. The PGA intraRR was assessed in three studies [10, 68, 94] and ranged from 0.55 [68] to 0.88 [10]. Clinical composite measures of disease activity and damage used to evaluate patients with systemic lupus erythematosus: A systematic literature review. , Klein-Gitelman MS Physician training is very important. , Roberts WN A good responsiveness for PGA was shown in eight studies. Over the years, PGA-IGA scales were modified for the purpose of clinical settings and thus present a diversity in the number of response options (4 to 10 points), the response options label and the . Physician Global Assessment (PGA) is a visual analogue score (VAS) that reflects the clinician's judgment of overall Systemic Lupus Erythematosus (SLE) disease activity. sharing sensitive information, make sure youre on a federal The correlation with the SLEDAI was determined in 12 studies (Fig. The Senior Lead will be responsible for: Managing end to end production, governance and controls of Derivatives Standardized and Advanced RWA, and SLE Actuals. et al. An acceptable reliability is indicated by values of intraclass correlation coefficient (ICC) or weighted >0.60 and a good reliability is >0.85 [20]. The anonymous patientcompleted questionnaire comprised the following: current pain in the past 7 days (10cm VAS [0 no pain; 10 most severe pain]), patient global assessment (PtGA) of health status (10 cm VAS [0 very well; 10 very poorly]), ever and current recreational cannabis use, ever and current medical cannabis use, and if cannabis . et al. , Rairie JE Data regarding divergent validity are lacking for the PGA. , Schur PH. The responsiveness of the PGA was assessed through different methods [109, 113] showing a high sensitivity for detecting clinical variations [84]. 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. A good responsiveness for PGA was shown in eight studies. SELENA SLEDAI4. All rights reserved. et al. (PGA) scoring of disease activity in systemic lupus erythematosus (SLE). , Beaumont JL Before , McGuire JL. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. 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). Injuries requiring medical treatment are considered to be "reportable incidents," and must be reported to the NJDOE within five working days of the occurrence. 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. BICLA is a validated composite global measure of SLE disease activity including SLEDAI-2K, CLASI-A, OCS dosage reduction, and patient-reported outcomes. . Currently no agreement has been reached on which scale should be used: a pointed scale with anchored values (0, 1, 2, 3) or a centimetric scale with all values between 0.0 and 3.0. 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. , Urowitz MB et al. , Cella D. van Vollenhoven RF FOIA Trusted for over 30 years to provide and transform technology into complete solutions that advance the value of IT. , Petri MA , Shea BJ , Vogel-Claussen J , Weisman MH. . et al. . In one open-label study [43], the decrease in PGA score was considered the primary endpoint. , Tugwell P Improving patient pathways for systemic lupus erythematosus: a multistakeholder pathway optimisation study. Results of a large, multicentric, nationwide study, American College of Rheumatology provisional criteria for global flares in childhood-onset systemic lupus erythematosus, A cross-sectional study of hydroxychloroquine concentrations and effects in people with systemic lupus erythematosus, Inactive disease and remission in childhood-onset systemic lupus erythematosus, Preliminary criteria for global flares in childhood-onset systemic lupus erythematosus, Systemic lupus erythematosus in a multiethnic US cohort, XXXVII: association of lymphopenia with clinical manifestations, serologic abnormalities, disease activity, and damage accrual, Systemic lupus erythematosus in a multiethnic cohort (LUMINA): XXIX. In support of its face validity, the PGA was used to define the disease activity score in all 91 studies retrieved by the literature search, having a role as an outcome measure as well as a comparator to assess the validity of other indices. The Physician Global Assessment (PGA) is a visual analogue score that reflects the clinicians judgement of overall SLE disease activity. Manzi S , Karp DR PGA is a simple instrument and the result is easily understood. Medizinische Universitt Graz Austria/sterreich - Forschungsportal - Medical University of Graz Direkt zur Navigaton springen . [8] suggested the need for a disease activity instrument that would be valid, reliable and sensitive to change. , Matos A It is therefore desirable to use the PGA along with other tools (typically the SLEDAI) or to include the PGA in a composite index (e.g. et al. PMC 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. Akhter E Ruiz-Irastorza G et al. , Oon S 12. and later incorporated into the SLE Responder Index used in the belimumab clinical trials, 13 . et al. , Beresford MW 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]). [80] considered worsening as any increase in the PGA from baseline; in the epratuzumab trial [87], a significant improvement was a 20% decrease in the PGA score evaluated after 12months of treatment. Devilliers H , Mazur M. Fatemi A Reliability. SLE or at an SLE site, but only if the injury requires treatment by a licensed medical doctor. , Altman DG Objectives Remission in systemic lupus erythematosus (SLE) is defined through a combination of 'clinical SLE Disease Activity Index (cSLEDAI)=0', 'physician's global assessment (PGA) <0.5 . Merrill JT . Petri M , Jolly M. Antony A SLE3. , Buyon J et al. The term Physician Global Assessment (PGA) was coined in 1991 by Petri et al. , Magder LS , Seaman AL Newark, New Castle, USA, March 03, 2023 (GLOBE NEWSWIRE) -- The global complement-targeted therapeutics market is expected to grow at a CAGR of 8.9% from 2022 to 2030, owing to the rising . BATCH RUBY INTENSIVE REVIEWRTRMF 3. Direkt zum Inhalt springen . , Hochberg M. Touma Z et al. , James JA The 4-point PGA (0, no flare; 1, mild; 2, moderate; 3, severe) showed the lowest IRR in assessing flare (ICC=0.18) compared with the BILAG-2004 (ICC=0.54) and SFI (ICC=0.21) [65]. Please enable it to take advantage of the complete set of features! Schlencker A, Messer L, Ardizzone M, Blaison G, Hinschberger O, Dahan E, Sordet C, Walther J, Dory A, Gonzalez M, Kleinlogel S, Bramont-Nachman A, Barrand L, Payen-Revol I, Sibilia J, Martin T, Arnaud L. Lupus Sci Med. In the absence of a consensus, Aranow [26] found a better correlation between the SLEDAI and the PGA when the latter was assessed taking into account laboratory test results. , Holland M , Emamikia S doi: 10.1136/rmdopen-2022-002395. et al. Visual analogue scales (VAS) allow rapid, continuous scaling of disease severity. Twenty-nine studies [25, 31, 3439, 41, 43, 48, 49, 5355, 59, 6164, 74, 75, 81, 82, 86, 92, 93, 96, 97] have assessed criterion validity of the PGA (Table2). The company serves physicians and patients. , Mina R 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]). All articles published through 1 July 2019 in PubMed were screened, with no limitation on year of publication, language or patients' age. , Koutsoviti S In an epratuzumab trial, the absence of deterioration of the PGA (not >10% worsening) was one of the items to achieve a BILAG-based Composite Lupus Assessment (BICLA) response [105]. Disagreements between investigators were solved by consensus. Even though the PGA showed optimal reliability, a very low interRR for flare using the PGA (ICC=0.18) was found in a single study [65] compared with that of the BILAG (ICC=0.54) or SFI (ICC=0.21). Gladman DD , Shinada S Moher D 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]. . The Systemic Lupus Activity Measure-revised, the Mexican Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and a modified SLEDAI-2K are adequate instruments to measure disease activity in systemic lupus erythematosus. , Urowitz MB 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]. , Matos A Stojan G , Ko T Eudy AM Methods: , Annapureddy N , Bresee C et al. We analysed the performance of the SELENA SLEDAI Physician's Global Assessment (SSPGA) and the Lupus Foundation of America-Rapid Evaluation of Activity in Lupus (LFA-REAL) as measures . , Morabito LM National Library of Medicine 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. The SELENA-SLEDAI assesses systemic lupus erythematosus (SLE) disease activity and categorizes mild/moderate or severe flares based on changes in the SLEDAI score, the Physician's Global Assessment (PGA), medication use (prednisone, Nonsteroidal anti-inflammatory drugs, Plaquenil, major immunosuppressives), other disease activity criteria, and . IgM) on attainment PhGA. Psychometric properties data were analysed according to the OMERACT Filter methodology version 2.1. Myelogram - correct answer NPO for 4-6 hours. Matthew Turk,1,2 Janet E Pope1,2 To cite: turk M, Pope Je. An international panel of 79 SLE experts participated in a three-round Delphi consensus process, in which 41 statements related to the PGA in SLE were . Systemic lupus erythematosus (SLE) is a multisystem autoimmune rheumatic disease (ARD) characterized by flares and remissions. No study has evaluated the feasibility of the PGA in SLE to date. Thanou A, Chakravarty E, James JA, Merrill JT. No data were found regarding the feasibility of the PGA. The PGA is intended to encapsulate the physician's judgement of overall disease activity.Consensus on whether the PGA should be performed prior to, or after the receipt of laboratory values is lacking. In 89 studies [2, 3, 913, 21102] the PGA was used to measure disease activity as a whole, therefore satisfying the content validity criteria. All clinical diagnoses were verified by review of the patients' inpatient and outpatient files at the time of capillaroscopy. Nehring J , Rodrigues M , Su J , Gladman DD , Hynan LS , Borghoff K A high variability in scales was found, causing a wide range of reliability (intraclass correlation coefficient 0.67-0.98). , Wallace DJ Physician Global Assessment International Standardisation COnsensus in Systemic Lupus Erythematosus: the PISCOS study . Different scores and lengths of visual evaluation were employed: the first was the 010 VAS suggested by Liang et al. , Jnsen A (PGA), physician global assessment of disease activity (PHGA), C3, C4, and Anti-ds . Uribe AG, Vil LM, McGwin G Jr, Sanchez ML, Reveille JD, Alarcn GS. Assessing disease activity in rheumatic diseases such as systemic lupus erythematosus (SLE) is vital for effective treatment. Nevertheless, despite the fact that the PGA was considered the reference in 39 studies involving other indices, it was used as the sole instrument in only 2 of them. , Siega-Riz AM How should lupus flares be measured? The PGA is usually reported by experts as allowing exhaustive coverage of the concept of disease activity in SLE [20, 108]. Arthritis Res Ther. Deconstruction of the safety of estrogen in lupus erythematosus national assessment-systemic lupus erythematosus disease activity index flare index. watch for seizures after the procedure. Barr SG , Ravelli A , Friebus-Kardash J et al. At least 1 issue from each virtual tour. Patient-reported outcomes (PROs) reflect the patient's perspective and are used in rheumatoid arthritis (RA) routine clinical practice.