BILAG-2004 index captures systemic lupus erythematosus disease activity better than SLEDAI-2000

Reference:

Yee, C. S., Isenberg, D. A., Prabu, A., Sokoll, K., Teh, L. S., Rahman, A., Bruce, I. N., Griffiths, B., Akil, M., McHugh, N. J., D'Cruz, D., Khamashta, M. A., Maddison, P., Zoma, A. and Gordon, C., 2008. BILAG-2004 index captures systemic lupus erythematosus disease activity better than SLEDAI-2000. Annals of the Rheumatic Diseases, 67 (6), pp. 873-876.

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Official URL:

http://dx.doi.org/10.1136/ard.2007.070847

Abstract

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). 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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