Rheumatology Advance Access originally published online on June 16, 2003
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Rheumatology 2003; 42: 1372-1379
© 2003 British Society for Rheumatology
Definition and treatment of lupus flares measured by the BILAG index
Department of Rheumatology, Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham, B15 2TT, 1The University College London Hospitals, Centre for Rheumatology, Arthur Stanley House, 40–50 Tottenham Street, London W1P 9PG, UK and 2Fachklinik fur Rehabilitation Rheumatologie Osteoporose, aarReha Schinznach, Badstrasse 55, CH-5116 Schinznach-Bad, Switzerland.
Correspondence to:
C. Gordon. E-mail: p.c.gordon{at}bham.ac.uk
Objectives. The BILAG index is a clinical measure of lupus disease activity. It is valid, reliable and sensitive to change. Scoring in the BILAG index is based upon the physician's intention to treat. A flare of active lupus is defined as a new A or B score in at least one system. The main aim of this study was to determine whether patients with a lupus flare are treated as expected from the principles upon which the scoring system was devised. Secondly we wanted to establish whether patients with a new B score preceded by a C should be considered to have flared, as with patients scoring B following a D or E score.
Methods. Over a 12-month period, 250 patients regularly attending lupus clinics in Birmingham and London were assessed using the BILAG index at each visit.
Results. A new A or B score was observed in 154 (61.6%) patients. An A flare was observed in 26 (10.4%) patients. A B flare (in which the B score was preceded by a D or E score) was observed in 65 (26.0%) patients. There were 63 (25.2%) patients in whom there was a B score in a system in which a C score was previously recorded. Steroids were started or increased in 20 (77%) patients with an A flare. Almost all (92%) patients with a new A score had some increase in therapy. For the patients with new B scores, 53 (41%) had some increase in therapy, but multiple reasons were found for no change in therapy in 75 (59%) of these patients. There was no difference in the treatment of new B scores arising after a previous C score compared with previous D or E scores. Non-Caucasians were more likely to have a lupus flare than Caucasians.
Conclusions. These results are consistent with the principles upon which the BILAG index was devised and suggest that a moderate disease flare can be defined as a new B score following a C, D or E score according to the BILAG index.
KEY WORDS: Lupus, SLE, BILAG, Disease activity index, Flare, Ethnic.
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