TABLE 2
2019 EULAR/ACR SLE classification criteria
Patients must have antinuclear antibodies positive ≥1/80
SLE diagnosis is possible if a patient has 10 or more points
All patients
suspected of
having SLE
should be
referred to a
rheumatologist
or to a SLE
specialist
to confirm
diagnosis and
be involved in
ongoing care
Points
Immunological domains
Clinical domains
Constitutional
2
Complement proteins domain
Fever
3
Low C3 or C4
Cutaneous
Low C3 and C4
2
Antiphospholipid antibodies domain
Non-scarring alopecia
Oral ulcers
2
Anti-Cardiolipin or
anti-β2-GPI or lupus anticoagulant
4
Highly specific antibodies domain
Subacute cutaneous or discoid lupus
6
Anti-Sm or Anti-dsDNA
Acute cutaneous lupus
6
Arthritis domain
Synovitis in at least two joints or
tenderness in at least two joints, and
at least 30 minutes of morning stiffness
Neurologic domain
Delirium 2
Psychosis 3
Seizure 5
Serositic domain
Pleural or pericardial effusion
5
6
Acute pericarditis
Haematologic domain
Leukopaenia 3
4
Autoimmune haemolysis
or thrombocytopaenia
Renal domain
4
Proteinuria ≥0.5g/day
Class II/V nephritis
8
Class III/IV nephritis
10
clinical and laboratory examinations should be
carried out every 6–12 months. 7 Patients with
active or more severe disease, with complications
related to the treatment, as well as when
immunosuppressant treatment is introduced or
reduced, will need more frequent control.
How to monitor a SLE patient
SLE is a very heterogeneous disease and its
activity fluctuates over time. This variability
means that patients with SLE require standardised
and objective monitoring of the disease, with
validated instruments to determine the degree
of activity.
The use of an activity index is also desirable
in routine clinical practice as a way of guiding
therapeutic decisions as objectively as possible.
Moreover, clinicians have to be able to distinguish
disease activity from chronic damage, infection
and other comorbid disease, including drug side
effects.
Many indices have been proposed and all of
these have been proven to be valid to measure the
activity of SLE and they are also able to predict
damage and mortality. 8 In addition to the
Physicians’ Global Assessment (an estimate of
activity rated on a 0 to 3 visual analogue scale),
the most common measures used include the SLE
Disease Activity Index (SLEDAI), the British Isles
Lupus Assessment Group (BILAG), the Systemic
Lupus Activity Measure (SLAM), the Lupus Activity
Index (LAI), and the European Consensus Lupus
Activity Measurement (ECLAM).
The SLEDAI index and its latest version
5
HHE 2019 | hospitalhealthcare.com
Points
3
4
2
6
SLEDAI-2K 9 is one of the most commonly used
global disease activity measure in clinical practice
and clinical trials (Table 4). The score has
demonstrated validity, reliability, and sensitivity
to change in several observational studies. The
practical applicability of SLEDAI-2K in clinical
settings, its ease of administration (less than
10 minutes to completed), and its simplicity in
scoring are fundamental properties. The
SLEDAI-2K includes the evaluation of 24 weighted
objective variables (16 clinical and 8 laboratory;
Table 4). A manifestation is recorded if it is
present over the past 10 days. The sum of the
items, identified in a single patient, corresponds
to the disease activity. Concerning the laboratory
items, the SLEDAI includes the determination of
complement levels and of anti-dsDNA antibodies.
The main limitation is that the SLEDAI-2K is not
able to capture improvements or worsenings
within an organ system, and it does not include
severity. By contrast, the BILAG score 10 (Figure 1)
refers to disease activity in nine organ systems
in the previous 30 days. For each item included,
a score is assigned according to the degree
of disease activity. The BILAG is the most
comprehensive activity index, and it has the
power to detect changes in the activity of the
disease, therefore it is frequently used in
randomised clinical trials. However, it is longer
than SLEDAI to complete (almost one hour),
it requires several laboratory parameters and
a dedicated software. In conclusion, it is not
feasible in everyday practice.
Other than disease activity, damage caused