SLEDAI-2K Calculator (Systemic Lupus Erythematosus Disease Activity Index 2000)

This SLEDAI 2K calculator evaluates changes in the condition of patients diagnosed with lupus erythematosus.

Detailed information about the score, along with guidelines on its components, can be found in the text following the tool.


Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) stratifies severity of SLE based on 24 variables and helps clinicians evaluate disease activity, especially in the context of studies on response to treatment.


SLEDAI score, which is the sum of 24 individual item scores, ranges from 0 to 105. A higher score indicates increased disease activity. A score of 6 or higher generally signifies a need for therapy. However, it's noteworthy that scores exceeding 45 are uncommon in clinical settings.


1Recent onset seizure Exclude metabolic, infectious, or drug causes
2Psychosis 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, and bizarre, disorganized, or catatonic behavior); exclude uremia and drug causes
3Organic brain syndrome Altered mental function with impaired orientation, memory, or other intellectual function (with rapid onset and fluctuating clinical features), inability to sustain attention to environment, and ≥2 of the following: perceptual disturbance, incoherent speech, insomnia or daytime drowsiness, and increased or decreased psychomotor activity; exclude metabolic, infectious, or drug causes
4Visual disturbance Retinal changes of SLE (include cytoid bodies, retinal hemorrhages, serous exudates or hemorrhages in choroid, and optic neuritis); exclude hypertensive, infectious, or drug causes
5New onset sensory or motor neuropathy involving cranial nerves
6Lupus headache Severe, persistent headache (may be migrainous but must be nonresponsive to narcotic analgesia)
7New onset stroke Exclude arteriosclerosis
8Vasculitis Ulceration, gangrene, tender finger nodules, periungual infarction, splinter hemorrhages or biopsy, and angiogram proof of vasculitis
9Arthritis ≥2 joints with pain and signs of inflammation (i.e., tenderness, swelling, or effusion)
10Myositis Proximal muscle aching/weakness associated with elevated CPK/aldolase, EMG changes, or a biopsy showing myositis
11Heme-granular or RBC urinary casts
12Hematuria >5 RBC/high-power field; exclude stone, infection, or other cause
13Proteinuria >0.5 g/24 hours
14Pyuria >5 WBC/high-power field; exclude infection
15Inflamatory-type rash
16Alopecia
17Oral or nasal mucosal ulcers
18Pleuritic chest pain with pleural rub/effusion or pleural thickening
19Pericarditis Pericardial pain with ≥1 of the following: rub, effusion, or EKG/echocardiogram confirmation
20Low complement CH50, C3, or C4 decreased below lower limit of normal for lab
21High DNA binding Increased above normal range for lab
22Temp >100.4 °F (38°C) Exclude infectious causes
23Platelets <100 x 109/L Exclude drug causes
24WBC <3 x 109/L Exclude drug causes
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1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.


 

SLEDAI-2K Score explained

Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) helped standardize outcome measures in SLE and is a clinical tool predominantly used in research to track disease activity and response to therapy.

The SLEDAI score calculator consists of a list of 24 items, 16 clinical and 8 laboratory results, each being described in the table below.

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 >100.4°F (38°C). Exclude infectious cause.
23 Thrombocytopenia 1 <100,000 platelets/mm3
24 Leukopenia 1 <3,000 White blood cell/mm3. Exclude drug causes.

SLEDAI score (obtained by adding the individual 24 item scores) ranges from 0 to 105, where the higher the score, the greater the degree of disease activity.

Scores of 6 or more are consistent with therapy requirement. It was found that scores of more than 45 are actually very rare clinically.

It 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.

 

About the original study

SLE outcomes can be adequately described by three indices: disease activity, damage from disease, and health status. The SLEDAI and the subsequent modification SLEDAI 2K (which allows for persistent activity in rash, mucous membranes, alopecia, and proteinuria) addresses the need to evaluate disease activity.

The SLEDAI predicted well the physicians' ratings in the testing set (Pearson's correlation coefficients = 0.64-0.79).

SLEDAI 2K has been validated against the original SLEDAI in a study on a cohort of 960 patients, as a predictor for mortality and as a measure of global disease activity in the clinic. SLEDAI-2K correlated highly (r = 0.97) with SLEDAI. Both methods for SLEDAI scoring predicted mortality equally (p = 0.0001), and described similarly the range of disease activity as recognized by the clinician.

 

References

Original references

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.

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

Validation

Gladman DD, Goldsmith CH, Urowitz MB, Bacon P, Bombardier C, Isenberg D, Kalunian K, Liang MH, Maddison P, Nived O, et al. Crosscultural validation and reliability of 3 disease activity indices in systemic lupus erythematosus. J Rheumatol. 1992 Apr;19(4):608-11

Yee CS, Farewell VT, Isenberg DA, Griffiths B, Teh LS, Bruce IN, Ahmad Y, Rahman A, Prabu A, Akil M, McHugh N, Edwards C, D'Cruz D, Khamashta MA, Gordon C. The use of Systemic Lupus Erythematosus Disease Activity Index-2000 to define active disease and minimal clinically meaningful change based on data from a large cohort of systemic lupus erythematosus patients. Rheumatology (Oxford). 2011 May;50(5):982-8.

Other references

Hawker, G., Gabriel, S., Bombardier, C., Goldsmith, C., Caron, D., & Gladman, D. (1993). A reliability study of SLEDAI: A disease activity index for systemic lupus erythematosus. Journal of Rheumatology, 20(4), 657-660.


Specialty: Disability

Objective: Monitoring

Type: Index

No. Of Variables: 24

Year Of Study: 1992

Abbreviation: SLEDAI

Article By: Denise Nedea

Published On: January 4, 2024 · 12:00 AM

Last Checked: January 4, 2024

Next Review: January 4, 2029