TABLE 4
Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K)
Weight Item Description
8
Seizure
8
Psychosis
Organic brain syndrome
8
Visual
8
8
Cranial nerve
8
Lupus headache
8
Cerebrovascular accident
Vasculitis
8
Arthritis
4
4
Myositis
4
Casts
4
Haematuria
Proteinuria
4
Pyuria
4
2
New malar rash
2
Alopecia
2
Mucous membranes
2
Pleurisy
2
Pericarditis
2
Low complement
2
Increased DNA binding
1
Fever
1
Thrombocytopaenia
1
Leukopaenia Recent onset. Exclude metabolic, infectious, or drug-related causes
Altered ability to function in normal activity due to severe
disturbance in the perception of reality. Includes hallucinations;
incoherence; marked loose associations; impoverished thought
content; marked illogical thinking; bizarre, disorganised or catatonic
behaviour. Exclude the presence of uraemia and offending drugs
Altered mental function with impaired orientation or impaired
memory or syndrome other intellectual function, with rapid onset
and fluctuating clinical features. Includes a clouding of
consciousness with a reduced capacity to focus and an inability to
sustain attention on environment, and at least two of the following:
perceptual disturbance, incoherent speech, insomnia or daytime
drowsiness, increased or decreased psychomotor activity. Exclude
metabolic, infectious, and drug-related causes
Retinal changes from systemic lupus erythematosus: cytoid bodies,
retinal haemorrhages, serous exudates or haemorrhages in the
choroid, optic neuritis (not due to hypertension, drugs, or infection)
New onset of a sensory or motor neuropathy involving a cranial
nerve
Severe, persistent headache; may be migranous; unresponsive to
narcotics
New syndrome. Exclude arteriosclerosis
Ulceration, gangrene, tender finger nodules, periungual infarction,
splinter haemorrhages. Vasculitis confirmed by biopsy or angiogram
More than two joints with pain and signs of inflammation
Proximal muscle aching or weakness associated with elevated
creatine phosphokinase/aldolase levels, electromyographic changes,
or a biopsy showing myositis
Heme, granular, or erythrocyte
More than 5 erythrocytes per high power field. Exclude other causes
(stone, infection)
More than 0.5g urinary protein excreted per 24h. New onset
or recent increase of >0.5g/24h
More than five leukocytes per high-power field. Exclude infection
New onset or recurrence of an inflammatory type of rash
New or recurrent. A patch of abnormal, diffuse hair loss
New onset or recurrence of oral or nasal ulcerations
Pleuritic chest pain with pleural rub or effusion, or pleural thickening
Pericardial pain with at least one of rub or effusion. Confirmation by
electro- or echocardiography
A decrease in CH50, C3, or C4 level (to less than the lower limit of the
laboratory-determined normal range)
More than 25% binding by Farr assay (to >the upper limit of the
laboratory-determined normal range, for example, 25%)
More than 38ºC after the exclusion of infection
Fewer than 100,000 platelets
Leukocyte count of <3000/mm 3 (not due to drugs)
well as promp recognition and treatment.
Patients with SLE should receive vaccinations
as proposed by EULAR in the recommendations
for vaccination of patients with autoimmune
rheumatic diseases. 24 Seasonal influenza and
pneumococcal vaccination are strongly
recommended for patients with SLE, preferably
during stable disease. 24,26 Live attenuated vaccines
are not recommended in patients chronically
treated with immunosuppressant therapies
because of the risk of disseminated infections.
Osteoporosis
Osteopaenia and osteoporosis are frequent
comorbidities in SLE patients and the disease
8
HHE 2019 | hospitalhealthcare.com
itself represents an independent risk factor for
low bone mineral density (BMD), but there are
additional risk factors that may concur, such as
therapy with glucocorticoids and the high
prevalence of vitamin D insufficiency or
deficiency, 27 favoured also by the doctor’s
prescribed lifestyle. BMD score should be
evaluated at disease onset, and the ongoing
EULAR recommendations suggest the
supplementation of elemental calcium and
cholecalciferol in all patients chronically treated
with low-medium dosage of corticosteroids. 28
In case of vitamin D deficiency, higher dosage
should be initially prescribed and then lowered to
a standard dosage of cholecalciferol (600 – 800IU/