Rheumatology Advance Access published online on June 16, 2003
Rheumatology, doi:10.1093/rheumatology/keg382
Rheumatology © British Society for Rheumatology 2003; all rights reserved
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Original Papers
1 Department of Rheumatology, Division of Immunity and Infection, The Medical School, University of Birmingham, Edgbaston, Birmingham, UK
* Corresponding author. E-mail: p.c.gordon{at}bham.ac.uk.
Received 23 August 2002
; accepted 19 March 2003
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.
Definition and treatment of lupus flares measured by the BILAG index
2 The University College London Hospitals, Centre for Rheumatology, London, UK
3 The University College London Hospitals, Centre for Rheumatology, London, UK; Fachklinik fur Rehabilitation Rheumatologie Osteoporose, aarReha Schinznach, Schinznach-Bad, Switzerland
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. PETRI, S. SINGH, H. TESFASYONE, and A. MALIK Prevalence of Flare and Influence of Demographic and Serologic Factors on Flare Risk in Systemic Lupus Erythematosus: A Prospective Study J Rheumatol, November 1, 2009; 36(11): 2476 - 2480. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. O. BINGHAM III, C. POHL, T. G. WOODWORTH, S. E. HEWLETT, J. E. MAY, M. U. RAHMAN, J. P. WITTER, D. E. FURST, C. V. STRAND, M. BOERS, et al. Developing a Standardized Definition for Disease "Flare" in Rheumatoid Arthritis (OMERACT 9 Special Interest Group) J Rheumatol, October 1, 2009; 36(10): 2335 - 2341. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Gordon, D. J. Wallace, S. Shinada, K. C. Kalunian, L. Forbess, G. D. Braunstein, and M. H. Weisman Testosterone patches in the management of patients with mild/moderate systemic lupus erythematosus Rheumatology, March 1, 2008; 47(3): 334 - 338. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Bowman, N. Sutcliffe, D. A. Isenberg, F. Goldblatt, M. Adler, E. Price, A. Canavan, J. Hamburger, A. Richards, S. Rauz, et al. Sjogren's Systemic Clinical Activity Index (SCAI) a systemic disease activity measure for use in clinical trials in primary Sjogren's syndrome Rheumatology, December 1, 2007; 46(12): 1845 - 1851. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Hale, G. Treharne, Y Norton, A. Lyons, K. Douglas, N Erb, and G. Kitas 'Concealing the Evidence': The Importance of Appearance Concerns for Patients with Systemic Lupus Erythematosus Lupus, August 1, 2006; 15(8): 532 - 540. [Abstract] [PDF]
|
|
|
|
|
|
E. Allen, V. T. Farewell, D. A. Isenberg, and C. Gordon A statistical analysis of the interrelationships between disease activity in different systems in systemic lupus erythematosus Rheumatology, March 1, 2006; 45(3): 308 - 313. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Isenberg, A. Rahman, E. Allen, V. Farewell, M. Akil, I. N. Bruce, D. D'Cruz, B. Griffiths, M. Khamashta, P. Maddison, et al. BILAG 2004. Development and initial validation of an updated version of the British Isles Lupus Assessment Group's disease activity index for patients with systemic lupus erythematosus Rheumatology, July 1, 2005; 44(7): 902 - 906. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Stevens, J. Hamburger, J. R. Ainsworth, G. Holmes, and S. J. Bowman Flares of systemic disease in primary Sjogren's syndrome Rheumatology, March 1, 2005; 44(3): 402 - 403. [Full Text] [PDF]
|
|
|
|
|
|
T. Stoll, N. Sutcliffe, J. Mach, R. Klaghofer, and D. A. Isenberg Analysis of the relationship between disease activity and damage in patients with systemic lupus erythematosus--a 5-yr prospective study Rheumatology, August 1, 2004; 43(8): 1039 - 1044. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V Strand Clinical trial design in systemic lupus erythematosus: lessons learned and future directions Lupus, May 1, 2004; 13(5): 406 - 411. [Abstract] [PDF]
|
|