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BILAG-2004 index captures systemic lupus erythematosus disease activity better than SLEDAI-2000
  1. C-S Yee1,
  2. D A Isenberg2,
  3. A Prabu1,
  4. K Sokoll3,
  5. L-S Teh4,
  6. A Rahman2,
  7. I N Bruce5,
  8. B Griffiths6,
  9. M Akil7,
  10. N McHugh8,
  11. D D’Cruz9,
  12. M A Khamashta9,
  13. P Maddison10,
  14. A Zoma11,
  15. C Gordon1
  1. 1
    University of Birmingham, Birmingham, UK
  2. 2
    University College London, London, UK
  3. 3
    University of Leeds, Leeds, UK
  4. 4
    Royal Blackburn Hospital, Blackburn, UK
  5. 5
    University of Manchester, Manchester, UK
  6. 6
    Freeman Hospital, Newcastle-upon-Tyne, UK
  7. 7
    Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
  8. 8
    Royal National Hospital for Rheumatic Diseases NHS Trust, Bath, UK
  9. 9
    St Thomas’ Hospital, London, UK
  10. 10
    University of Wales, Bangor, UK
  11. 11
    Hairmyres Hospital, Lanarkshire, UK
  1. Dr Chee-Seng Yee, Clinical Research Fellow, Department of Rheumatology, Division of Immunity and Infection, The Medical School (East Wing), University of Birmingham, Birmingham B15 2TT, UK; csyee{at}


Objective: To assess the reliability of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2000 index in routine practice and its ability to capture disease activity as compared with the British Isles Lupus Assessment Group (BILAG)-2004 index.

Methods: Patients with systemic lupus erythematosus from 11 centres were assessed separately by two raters in routine practice. Disease activity was assessed using the BILAG-2004 and SLEDAI-2000 indices. The level of agreement for items was used to assess the reliability of SLEDAI-2000. The ability to detect disease activity was assessed by determining the number of patients with a 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 was analysed, and the increase in treatment was used as the gold standard for active disease.

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

Conclusions: SLEDAI-2000 is a reliable index to assess systemic lupus erythematosus disease activity but it is less able than the BILAG-2004 index to detect active disease requiring increased treatment.

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  • Funding: AP was funded by an unrestricted educational grant from Actelion Pharmaceuticals. CG received consulting fees and/or honoraria from Bristol Meyer Squibb, Genentech, Immunomedics, Roche, UCB Pharma and Aspreva.

  • Competing interests: None.

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