Unifying Concepts

Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)

Disease activity is assessed using a combination of the clinical history, physical examination, organ specific functional tests, and serologic studies.

Check box: If descriptor is present at the time of visit or in the proceeding 10 days

Score Present Descriptor Definition
8 Seizure Recent onset. Exclude metabolic, infectious or drug cause
8 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.
8 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.
8 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.
8 Cranial Nerve
New onset of sensory or motor neuropathy involving cranial nerves.
8 Lupus Headache Severe persistent headache: may be migrainous, but must be nonresponsive to narcotic analgesia.
8 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
4 Arthritis More than 2 joints with pain and signs of inflammation (i.e. tenderness, swelling, or effusion).
4 Myositis Proximal muscle aching/weakness, associated with elevated creatine phosphokinase/adolase or electromyogram changes or a biopsy showing myositis.
4 Urinary Casts Heme-granular or red blood cell casts
4 Hematuria >5 red blood cells/high power field. Exclude stone, infection or other cause.
4 Proteinuria >0.5 gm/24 hours. New onset or recent increase of more than 0.5 gm/24 hours.
4 Pyuria >5 white blood cells/high power field. Exclude infection.
2 New Rash New onset or recurrence of inflammatory type rash.
2 Alopecia New onset or recurrence of abnormal, patchy or diffuse loss of hair.
2 Mucosal Ulcers New onset or recurrence of oral or nasal ulcerations
2 Pleurisy Pleuritic chest pain with pleural rub or effusion, or pleural thickening.
2 Pericarditis Pericardial pain with at least 1 of the following: rub, effusion, or electrocardiogram confirmation.
2 Low Complement Decrease in CH50, C3, or C4 below the lower limit of normal for testing laboratory.
2 Increased DNA
>25% binding by Farr assay or above normal range for testing laboratory.
1 Fever >38°C. Exclude infectious cause
1 Thrombocytopenia <100,000 platelets/mm3
1 Leukopenia <3,000 White blood cell/mm3. Exclude drug causes.
TOTAL SCORE (Sum of weights next to descriptors marked present)


Mild or Moderate Flare Severe Flare
Change in SLEDAI > 3 points Change in SLEDAI > 12points
New/worse discoid, photosensitive, profundus, cutaneous vasculitis, bullous lupus
Nasopharyngeal ulcers
Fever (SLE)
New/worse CNS-SLE
Pk < 60.000
Home anemia: Hb <7% or decrease in Hb > 3%
Requiring: double prednisone
Prednisone >0.5 mg/kg/day hospitalization
Increase in Prednisone, but not to >0.5
Prednisone >0.5 mg/kg/day
Added NSAID or hydroxychloroquine New Cyclophosphamide, Azathioprine, Methotrexate, Hospitalization (SLE)
>/= 1.0 Increase in Physician’s Global Assessment (PGA), but not to more than 2.5 Increase in PGA to > 2.5



  1. Gladman DD, Ibañez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol. 2002 Feb;29(2):288-91. [Medline]
  2. Bencivelli W, Vitali C, Isenberg DA, Smolen JS, Snaith ML, Sciuto M, Bombardieri S. 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. 1992 Sep-Oct;10(5):549-54. [Medline]


Created: Aug 31, 2012.

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