SLE Disease Activity Index (SLEDAI) Calculator

This SLE Disease Activity Index (SLEDAI) calculator determines changes in the disease activity of patients diagnosed with lupus erythematosus. In the text below the form there is in depth information on the score and instructions on the items it consists of.

1 Seizure Recent onset. Exclude metabolic, infectious or drug cause.
2 Psychosis Altered ability to function in normal activity due to severe disturbance in the perception of reality. Include hallucinations, incoherence, marked loose associations, impoverished thought content, marked illogical thinking, bizarre, disorganized, or catatonic behavior. Excluded uremia and drug causes.
3 Organic Brain Syndrome Altered mental function with impaired orientation, memory or other intelligent function, with rapid onset fluctuating clinical features. Include clouding of consciousness with reduced capacity to focus, and inability to sustain attention to environment, plus at least two of the following: perceptual disturbance, incoherent speech, insomnia or daytime drowsiness, or increased or decreased psychomotor activity. Exclude metabolic, infectious or drug causes.
4 Visual Disturbance Retinal changes of SLE. Include cytoid bodies, retinal hemorrhages, serious exudate or hemorrhages in the choroids, or optic neuritis. Exclude hypertension, infection, or drug causes.
5 Cranial Nerve Disorder New onset of sensory or motor neuropathy involving cranial nerves.
6 Lupus Headache Severe persistent headache: may be migrainous, but must be nonresponsive to narcotic analgesia.
7 CVA New onset of cerebrovascular accident(s). Exclude arteriosclerosis.
8 Vasculitis Ulceration, gangrene, tender finger nodules, periungual, infarction, splinter hemorrhages, or biopsy or angiogram proof of vasculitis.
9 Arthritis More than 2 joints with pain and signs of inflammation (i.e. tenderness, swelling, or effusion).
10 Myositis Proximal muscle aching/weakness, associated with elevated creatine phosphokinase/adolase or electromyogram changes or a biopsy showing myositis.
11 Urinary Casts Heme-granular or red blood cell casts.
12 Hematuria >5 red blood cells/high power field. Exclude stone, infection or other cause.
13 Proteinuria >0.5 gm/24 hours. New onset or recent increase of more than 0.5 gm/24 hours.
14 Pyuria >5 white blood cells/high power field. Exclude infection.
15 New Rash New onset or recurrence of inflammatory type rash.
16 Alopecia New onset or recurrence of abnormal, patchy or diffuse loss of hair.
17 Mucosal Ulcers New onset or recurrence of oral or nasal ulcerations.
18 Pleurisy Pleuritic chest pain with pleural rub or effusion, or pleural thickening.
19 Pericarditis Pericardial pain with at least 1 of the following: rub, effusion, or electrocardiogram confirmation.
20 Low Complement Decrease in CH50, C3, or C4 below the lower limit of normal for testing laboratory.
21 Increased DNA Binding >25% binding by Farr assay or above normal range for testing laboratory.
22 Fever >38°C. Exclude infectious cause.
23 Thrombocytopenia <100,000 platelets/mm³
24 Leukopenia <3,000 White blood cell/mm³. Exclude drug causes.

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How does the SLE Disease Activity Index (SLEDAI) calculator work?

This health tool evaluates the lupus erythematosus disease activity based on a series of clinical and laboratory variables. It is based on the SLEDAI 2000 or SLEDAI 2K score, a modification of the original SLEDAI score.

This type of index is the most commonly used and one of the two major scoring systems (along BILAG) that evaluate the activity of lupus erythematosus.

The SLEDAI score calculator consists of a list of 24 items, 16 clinical and 8 laboratory results.

In the following table, these are identified, put along their weight in the score and described for a better understanding of their usage.

The SLEDAI 2K has been validated against the original score with a correlation of 0.97 and both methods are recognized as viable for clinical use.

No SLEDAI item Weight Description
1 Seizure 8 Recent onset. Exclude metabolic, infectious or drug cause.
2 Psychosis 8 Altered ability to function in normal activity due to severe disturbance in the perception of reality. Include hallucinations, incoherence, marked loose associations, impoverished thought content, marked illogical thinking, bizarre, disorganized, or catatonic behavior. Excluded uremia and drug causes.
3 Organic Brain Syndrome 8 Altered mental function with impaired orientation, memory or other intelligent function, with rapid onset fluctuating clinical features. Include clouding of consciousness with reduced capacity to focus, and inability to sustain attention to environment, plus at least two of the following: perceptual disturbance, incoherent speech, insomnia or daytime drowsiness, or increased or decreased psychomotor activity. Exclude metabolic, infectious or drug causes.
4 Visual Disturbance 8 Retinal changes of SLE. Include cytoid bodies, retinal hemorrhages, serious exudate or hemorrhages in the choroids, or optic neuritis. Exclude hypertension, infection, or drug causes.
5 Cranial Nerve Disorder 8 New onset of sensory or motor neuropathy involving cranial nerves.
6 Lupus Headache 8 Severe persistent headache: may be migrainous, but must be nonresponsive to narcotic analgesia.
7 CVA 8 New onset of cerebrovascular accident(s). Exclude arteriosclerosis
8 Vasculitis 8 Ulceration, gangrene, tender finger nodules, periungual, infarction, splinter hemorrhages, or biopsy or angiogram proof of vasculitis
9 Arthritis 4 More than 2 joints with pain and signs of inflammation (i.e. tenderness, swelling, or effusion).
10 Myositis 4 Proximal muscle aching/weakness, associated with elevated creatine phosphokinase/adolase or electromyogram changes or a biopsy showing myositis.
11 Urinary Casts 4 Heme-granular or red blood cell casts.
12 Hematuria 4 >5 red blood cells/high power field. Exclude stone, infection or other cause.
13 Proteinuria 4 >0.5 gm/24 hours. New onset or recent increase of more than 0.5 gm/24 hours.
14 Pyuria 4 >5 white blood cells/high power field. Exclude infection.
15 New Rash 2 New onset or recurrence of inflammatory type rash.
16 Alopecia 2 New onset or recurrence of abnormal, patchy or diffuse loss of hair.
17 Mucosal Ulcers 2 New onset or recurrence of oral or nasal ulcerations.
18 Pleurisy 2 Pleuritic chest pain with pleural rub or effusion, or pleural thickening.
19 Pericarditis 2 Pericardial pain with at least 1 of the following: rub, effusion, or electrocardiogram confirmation.
20 Low Complement 2 Decrease in CH50, C3, or C4 below the lower limit of normal for testing laboratory.
21 Increased DNA Binding 2 >25% binding by Farr assay or above normal range for testing laboratory.
22 Fever 1 >38°C. Exclude infectious cause.
23 Thrombocytopenia 1 <100,000 platelets/mm3
24 Leukopenia 1 <3,000 White blood cell/mm3. Exclude drug causes.

The SLEDAI has also been modified for use in the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) trial. The modified score is known as the SELENA-SEDAI system. It does not change the original scoring method but what it does is provide more clarity in some of the definitions of activity in individual items.

SLEDAI score interpretation

Once each item is evaluated, a score is calculated by adding the score given to each item based on the individual weights.

Organ involvement is weighted as follows: joint pain or kidney disease are multiplied by four while central nervous system neurological involvement is multiplied by eight.

■ The final score ranges between 0 and 105. The higher the score, the more significant is the degree of disease activity.

■ Scores of 6 and above are considered to be consistent with active disease requiring therapy. However, scores greater than 20 are very rare.

■ Modifications of score of 6 (improvement) and of 8 (worsening) are considered clinically relevant.

The score is predominantly used in research, usually to determine the changes in disease activity as consequence of a new therapy.

References

1) Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH, and the Committee on Prognosis Studies in SLE. (1992) The development and validation of the SLE Disease Activity Index (SLEDAI). Arthritis Rheum; 35:630-40.

2) Gladman DD, Ibañez D, Urowitz MB. (2002) Systemic lupus erythematosus disease activity index 2000. J Rheumatol; 29(2):288-91.

3) Touma Z, Urowitz MB, Taghavi-Zadeh S, Ibañez D, Gladman DD. (2012) Systemic lupus erythematosus disease activity Index 2000 Responder Index 50: sensitivity to response at 6 and 12 months. Rheumatology (Oxford); 51(10):1814-9.

4) Bencivelli W, Vitali C, Isenberg DA, Smolen JS, Snaith ML, Sciuto M, Bombardieri S. (1992) Disease activity in systemic lupus erythematosus: report of the Consensus Study Group of the European Workshop for Rheumatology Research. III. Development of a computerised clinical chart and its application to the comparison of different indices of disease activity. The European Consensus Study Group for Disease Activity in SLE. Clin Exp Rheumatol; 10(5):549-54.

05 Dec, 2016