In the past several decades more than 30 new treatments for lupus have failed in clinical trials, even though all had seemed promising in the test tube. These repeated failures take a toll on the people with lupus who participate in trials as well as on the people with lupus around the world who are waiting for better treatments.

The problem has many causes, but one important cause is the difficulty in measuring lupus disease activity. Each lupus person with lupus is unique and disease flares come and go in an unpredictable manner. A number of clinical outcome measures have been used in studies of people with lupus, and all are imperfect.

Anca D. Askanase, MD, MPH, Director of Columbia University Lupus Center and Associate Professor of Medicine, and Joan T. Merrill, MD, Director of Clinical Projects, Arthritis, & Clinical Immunology Program, Oklahoma Medial Research Foundation, discussed this problem in a recent paper published by Nature Reviews Rheumatology titled “Measuring disease activity in SLE is an ongoing struggle,” Existing disease activity measures are compared to recent publications of newer outcome tools, including the Lupus Foundation of America Rapid Evaluation of Activity in Lupus (LFA-REAL)[1], the SLE Disease Activity Index (SLEDAI) 2000 Responder Index 50 (SRI-50) [2], and the SLE Disease Activity Score (SLE-DAS) [3].

The authors review evidence that the LFA-REAL could be the most versatile of these measures. Nevertheless, further work to compare, contrast and establish the performance of these activity measures in clinical trials is needed.

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