Table 1

Criteria for major and minor relapses of SLE

Major relapse: fulfilling one or more of the following:1-150
1 Severe renal disease
 (a) decrease in creatinine clearance > 25% within 4 months, accompanied by an active sediment (> 5 erythrocyte sedimentation rate (mm 1st h), and/or casts), and proteinuria > 0.5 g/day
 (b) recent renal biopsy showing active proliferative lupus nephritis (> 50% of glomeruli affected)
2 Severe central nervous system disease
 seizures, cerebral vascular accident, coma, transverse myelitis, psychosis, choroathetosis, central nerve palsy
3 Haematological disease
 immune haemolytic anaemia (Hb < 60 g/l) and/or thrombocytopenia (< 50 × 109/l)
4 Severe serositis
 pericarditis with (impending) tamponade and/or massive pleural effusion
5 Uveitis and/or retinitis
6Myocarditis with arrhythmia and/or congestive heart failure
7 Severe myositis with proximal muscle weakness
8 Lung involvement with haemoptysis
9 Major vasculitis
 with ulcerations and/or mononeuritis multiplex
 fever (> 38° C rectally), serositis, haemolytic anaemia (> 60 g/l), or thrombopenia (> 50 × 109/l), all without improvement after prednisolone at a maximum dose of 30 mg/day for at least one week
Minor relapse: fulfilling all of the following:
1 Increase in SLE-DAI of ⩾ 2 points within 6 months, with a minimal activity index of 4 points, accompanied by:
2 The need to start prednisolone or immunosupressive drugs based on clinical evidence, and:
3 Not fulfilling the criteria for major relapse
  • 1-150 Only features present within two weeks of the outpatient consultation or relevant admission are taken into account. SLE disease activity index.