Rheumatology Strong — SLEDAI-2K 2002; international standard

SLEDAI-2K for SLE Disease Activity

Systemic Lupus Erythematosus Disease Activity Index 2000. 24-item weighted score measuring disease activity across 9 organ systems in the preceding 10 days.

Seizure (recent, not due to metabolic, infectious, or drug causes)*

Psychosis (altered perception, delusions, hallucinations)*

Organic brain syndrome (rapid-onset, fluctuating impairment of orientation, memory or attention; exclude metabolic, infectious or drug causes)*

Visual disturbance (retinal changes of SLE: cytoid bodies, retinal haemorrhage, choroidal exudate or haemorrhage, optic neuritis)*

Cranial nerve disorder (new)*

Lupus headache (severe, persistent, non-responsive to narcotic analgesia)*

CVA (new, not due to atherosclerosis)*

Vasculitis (ulceration, gangrene, tender finger nodules, periungual infarction, haemorrhage, biopsy or angiogram positive)*

Arthritis (≥ 2 joints with pain and signs of inflammation)*

Myositis (muscle pain/weakness + elevated CK/aldolase)*

Urinary casts (haem-granular or red blood cell casts)*

Haematuria (> 5 RBCs/hpf, exclude urolithiasis/infection)*

Proteinuria (> 0.5 g/24 h — new, recurrent or persistent)*

Pyuria (> 5 WBCs/hpf, not due to infection)*

Rash (inflammatory-type — new, recurrent or persistent)*

Alopecia (abnormal patchy or diffuse hair loss — new, recurrent or persistent)*

Mucosal ulcers (oral or nasal — new, recurrent or persistent)*

Pleurisy (pleuritic chest pain with rub or effusion)*

Pericarditis (pericardial pain with rub / ECG changes / effusion)*

Low complement (C3, C4, or CH50 below normal lab range)*

Increased anti-dsDNA binding (above the testing laboratory's normal range)*

Fever (> 38°C, no infectious cause)*

Thrombocytopenia (< 100 ×10⁹/L, not drug-induced)*

Leucopenia (WBC < 3.0 ×10⁹/L, not drug-induced)*

Score interpretation

No Activity 0

SLEDAI-2K = 0: No disease activity. Remission.

→ Continue maintenance therapy. Consider slow taper of immunosuppressants if sustained remission > 6–12 months. 3–6 monthly rheumatology review. Monitor: BP, urine PCR, FBC, renal function, anti-dsDNA, complement.

Mild Activity 1–5

SLEDAI-2K 1–5: mild disease activity (Mosca & Bombardieri 2006).

→ Continue or optimise hydroxychloroquine (adults: up to 5 mg/kg/day). Low-dose prednisolone for symptomatic control. Children: use a children's formulary. Rheumatology review in 4–8 weeks. Monitor renal function and urine PCR.

Moderate Activity 6–10

SLEDAI-2K 6–10: moderate disease activity. Escalation of therapy warranted.

→ Adults: prednisolone 0.5 mg/kg/day; add/optimise immunosuppressant: azathioprine (2 mg/kg/day) or mycophenolate mofetil (2–3 g/day). Children: use a children's formulary. Rheumatology review in 2–4 weeks. Check anti-dsDNA, complement, renal function.

High Activity 11–19

SLEDAI-2K 11–19: high disease activity.

→ Urgent rheumatology review. Adults: IV methylprednisolone 500mg–1g/day × 3 days for severe flare; prednisolone 1 mg/kg/day oral. Children: use a children's formulary. Cyclophosphamide IV (Euro-Lupus protocol) for severe nephritis or CNS involvement. Belimumab or voclosporin for renal disease. Rituximab for refractory disease. Nephrology referral for lupus nephritis ≥ Class III/IV.

Very High Activity 20–105

SLEDAI-2K ≥ 20: very high disease activity — organ- or life-threatening flare.

Interpretation bands for the SLEDAI-2K. Apply clinical judgement and local guidance.

References

Bombardier C, Gladman DD, Urowitz MB, et al. Derivation of the SLEDAI. A disease activity index for lupus patients. Arthritis Rheum. 1992;35(6):630–640.
Gladman DD, Ibañez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol. 2002;29(2):288–291.
Mosca M, Bombardieri S. Assessing remission in systemic lupus erythematosus. Clin Exp Rheumatol. 2006;24(6 Suppl 43):S99–S104.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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