Background Several instruments are used to assess disease activity in systemic lupus erythematosus (SLE). The majority of these depend on a physician's examination. Systemic Lupus Activity Questionnaire (SLAQ)  is a questionnaire, which is based on patients' assessments of lupus activity. SLAQ was originally developed from the instrument Systemic Lupus Activity Measure (SLAM) , which is filled out by physicians. SLAQ has demonstrated good reliability, construct validity and responsiveness in English speaking cohorts , but is not validated in Scandinavian languages.
Objectives The aim of this study was to compare patients' (SLAQ) to physicians' (SLAM) assessments of disease activity in SLE. Additionally we explored how self-assessed disease activity varied with disease duration
Methods Consecutive patients with SLE filled out the SLAQ questionnaire before meeting the physician, who evaluated disease activity according to SLAM. SLAQ scorings explored were; 1) SLAQ score (score 0-47), 24 symptom items analogues to SLAM, 2) Symptom Score (score 0-24) positive symptom responses, 3) Flare (score 0-3), presence and severity of lupus flares. 4) Patient numeric rating scale (PNRS, score 0-10), global disease activity. Additionally corresponding items on SLAQ and SLAM were explored. Spearman's rho was used to calculate correlations and Mann-Whitney U for comparisons.
Results 203 patients (79.3% women) were included, median age 45 (IQR 33-57), disease duration 5 years (IQR 0-14). Physician (SLAM-nolab) - patient correlations were good to moderate; SLAQ score (0.685), Symptom Score (0.651), Flares (0.547), PNRS (0.600). Six symptom items had good to moderate correlation between patients and physicians; fatigue (0.640), seizures (0.635), headache (0.604), Raynaud's (0.560), alopecia (0.508) and joint (0.512). The only symptom item with no correlation was neurological/stroke syndrome (0.109 p=251).
Patients with short disease duration less than a year (n=52, 25.6%), had a more active disease by both SLAM (median, IQR) (9, 5-13 vs 6, 3-9 p<0.001) and SLAQ-score (15, 10-20.75 vs 10, 6-16, p=0.004), Symptom score (11, 8-15 vs 9, 5-14 p=0.043), Flares (2,1-3 vs 0,0-1 p<0.001), PNRS (7,4-9 vs 3, 1-6 p<0.001).The correlations between patients and physicians assessment were lower for the patients with short disease duration SLAQ score (0.606), SLAQ symptom score (0.540), Flares (0.488) and PNRS (0.525).
Conclusions This study indicates that patient assessment by SLAQ can be used to assess disease activity in SLE. However patients with short disease duration had lower correlations indicating greater discrepancy between patients and physicians' assessments. Notably for the neurological/stroke syndrome there were no correlations between patients and physicians. Nevertheless SLAQ can be used in nursing clinics and in discussions between patients and health care providers. Further studies could evaluate if discussions or alterations of the questions can improve the agreement between SLAQ and health care providers interpretation of signs and symptoms in SLE.
Karlson, E.W., et al., Lupus, 2003.
Liang, M.H., et al., Arthritis Rheum, 1988.
Disclosure of Interest None declared