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BILAG-2004 Index captures SLE disease activity better than SLEDAI-2000
  1. Chee-Seng Yee (csyee{at}blueyonder.co.uk)
  1. University of Birmingham, United Kingdom
    1. David A Isenberg (c.cornborough{at}ucl.ac.uk)
    1. University College London, United Kingdom
      1. Athiveeraramapandian Prabu (a.prabu{at}bham.ac.uk)
      1. University of Birmingham, United Kingdom
        1. Katharina Sokoll (k.sokoll{at}leeds.ac.uk)
        1. University of Leeds, United Kingdom
          1. Lee-Suan Teh (lsteh{at}btinternet.com)
          1. Royal Blackburn Hospital, United Kingdom
            1. Anisur Rahman (anisur.rahman{at}ucl.ac.uk)
            1. University College London, United Kingdom
              1. Ian N Bruce (ian.bruce{at}manchester.ac.uk)
              1. University of Manchester, United Kingdom
                1. Bridget Griffiths (bridget.griffiths{at}nuth.nhs.uk)
                1. Freeman Hospital, United Kingdom
                  1. Mohammed Akil (m.akil{at}sheffield.ac.uk)
                  1. Royal Hallamshire Hospital, United Kingdom
                    1. Neil McHugh (neil.mchugh{at}rnhrd-tr.swest.nhs.uk)
                    1. Royal National Hospital for Rheumatic Disease, United Kingdom
                      1. David P D'Cruz (david.d'cruz{at}kcl.ac.uk)
                      1. St Thomas' Hospital, United Kingdom
                        1. Munther A Khamashta (munther.khamashta{at}kcl.ac.uk)
                        1. Lupus Research Unit, United Kingdom
                          1. Peter Maddison (peter.maddison{at}nww-tr.wales.nhs.uk)
                          1. North West Wales Rheumatology Service, United Kingdom
                            1. Asad Zoma (asad.zoma{at}lanarkshire.scot.nhs.uk)
                            1. Hairmyres Hospital, United Kingdom
                              1. Caroline Gordon (p.c.gordon{at}bham.ac.uk)
                              1. Birmingham University Medical School, United Kingdom

                                Abstract

                                Objective: To assess the reliability of SLEDAI-2000 index in routine practice and its ability to capture disease activity as compared to BILAG-2004 index.

                                Methods: SLE patients from 11 centres were assessed by 2 raters separately in routine practice. Disease activity was assessed using BILAG-2004 and SLEDAI-2000 indices. Level of agreement for items was used to assess the reliability of SLEDAI-2000. Ability to detect disease activity was assessed by determining the number of patients with high activity on BILAG-2004 (overall score A or B) but low SLEDAI-2000 score (< 6) and number of patients with low activity on BILAG-2004 (overall score C, D or E) but high SLEDAI-2000 score (≥ 6). Treatment of these patients were analysed and increase in therapy was used as the gold standard for active disease.

                                Results: 93 patients (90.3% women, 69.9% Caucasian) were studied: mean age 43.8 years, mean disease duration 10 years. There were 43 patients (46.2%) with a difference in SLEDAI-2000 score between the 2 raters and this difference was ≥ 4 in 19 patients (20.4%). Agreement for each of the items in SLEDAI-2000 was between 81.7 - 100%. 35 patients (37.6%) had high activity on BILAG-2004 but low SLEDAI-2000 score, of which 48.6% had therapy increased. There were only 5 patients (5.4%) with low activity on BILAG-2004 but high SLEDAI-2000 score.

                                Conclusions: SLEDAI-2000 is a reliable index to assess SLE disease activity but it is less able to detect active disease requiring increased therapy than BILAG-2004 index.

                                • BILAG-2004
                                • SLEDAI-2000
                                • disease activity
                                • inter-rater reliability
                                • systemic lupus erythematosus

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