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 |
| 10Miscellaneous |
| 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.