Physicians Global Assessment _______________________________
0
1
2
3
None
Mild
Med
Severe
SLEDAI Score
Check box: If descriptor is present at the time of visit or in the proceeding 10 days.
Wt |
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 exodate or hemorrhages in the choroids, or optic neuritis. Exclude hypertension, infection, or drug causes. |
8 |
□ |
Cranial Nerve Disorder |
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 binding |
>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 > 12 |
□ New/worse discoid, photoscnsitive, profundus, |
□ New/worse CNS-SLE |
□ Increase in Prednisone, but not to >0.5 mg/kg/day |
□ Prednisone >0.5 mg/kg/day |
□ Added NSAID or Plaquenil |
□ New Cytoxan, Azathioprine, Methotrexate, Hospitalization (SLE) |
□ ≥1.0 Increase in PGA, but not to more than 2.5 |
□ Increase in PGA to > 2.5 |
