POS0758 DOES EXPERIENCE IN SYSTEMIC LUPUS ERYTHEMATOSUS INFLUENCE THE PHYSICIAN GLOBAL ASSESSMENT SCORING? A CROSS-SECTIONAL STUDY ON TWO EUROPEAN COHORTS
Authors: E. Chessa, M. Piga, F. Sagez, R. Felten, A. Floris, A. Cauli, L. Arnaud
Journal: Annals of the Rheumatic Diseases (2021)

Background: The Physician Global Assessment (PGA) is an outcome instrument based on physician judgement of disease activity in patients with Systemic Lupus Erythematosus (SLE). Due to the subjectivity of the score and lack of standardization, the PGA could represent a source of heterogeneity, because the same manifestations could be rated differently by physicians with different backgrounds (1). Objectives: The purpose of this study was to evaluate the inter-rater reliability of PGA between a rheumatology trainee and rheumatologists expert in SLE from 2 european countries. Methods: SLE patients classified according to SLICC 2012 criteria were enrolled between May 2019 and December 2019 during a SLEuro traineeship program. Demographic, clinical (SLEDAI-2k, PGA), serological and ongoing medication data were collected. PGA was evaluated before (pre-lab) and after (post-lab) knowledge of laboratory exams, using a Visual Analogue Scale (VAS) ranging from 0 to 3, anchored at point 1 (mild), 2 (moderate) and 3 (severe activity). A trainee in Rheumatology (EC) and three rheumatologists experts in SLE (LA, MP, FS) independently scored the PGA for each patient. The trainee preliminarily received a standardization training with her tutor (MP), consisting of a shared discussion about 10 consecutive SLE outpatients to increase reliability in PGA scoring. Inter-rater reliability was analysed using the intraclass correlation coefficient (ICC) with a two-way single-rating model (2,1); 95% confidence interval (CI) was calculated. Results: Fifty-seven patients (86% female) affected from SLE (29 belonging to a French cohort and 28 to an Italian cohort) with a mean (SD) age 43.2 (15.9) years and a median [IQR] disease duration 6.4 [2.0-15.4] years were enrolled. Clinical features are presented in table 1. Pre-lab PGA scores were obtained from all patients and ranged from 0 to 2.3; post-lab PGA scores were obtained from 51 patients and ranged from 0 to 2.9. Inter-rater reliability of the PGA among the trainee was good to excellent for each lupus expert comparison: a) pre-lab PGA ICC 0.94, 95% CI 0.87-0.97; post-lab PGA ICC 0.94, 95% CI 0.87-0.97 (MP); b) pre-lab PGA ICC 0.84, 95% CI 0.63-0.93; post-lab PGA ICC 0.96 CI 0.88-0.99 (LA); c) pre-lab PGA ICC 0.91, 95% CI 0.65-0.98; post-lab PGA ICC 0.91, 95% CI 0.65-0.98 (FS). Conclusion: After an adequate standardization, PGA scoring reaches good to excellent reliability between trainee and experts. References: [1]Chessa E, Piga M, Floris A, Devilliers H, Cauli A, Arnaud L. Use of Physician Global Assessment in systemic lupus erythematosus: a systematic review of its psychometric properties. Rheumatology (Oxford). 2020 Dec 1;59(12):3622-3632. Clinical Data Caucasian 44 (77.2%) anti-dsDNA titre (median,IQR) 14 (0-75) Hypocomplementemia (n,%) 30 (54%) SLEDAI≥6 (n,%) 18 (31.6%) SLEDAI (median,IQR) 4 (2-6) Flares (n,%) 18 (31.6%) Ongoing prednisone treatment (n,%) 41 (71.9%) Prednisone dose mg (mean±sd) 5 (0 - 8.9) Hydroxychloroquine (n,%) 44 (77.2%) Immunosuppressant (n,%) 35 (61.4%) Acknowledgements: Elisabetta Chessa gratefully acknowledges the SLEuro European Lupus Society for its financial support in her traineeship in Strasbourg. Disclosure of Interests: None declared